Rhetorically Framing the “Inside Woman”: Female Healthcare Workers across Editions of Our Bodies, Ourselves

Doctors are doctor chauvinists as well as male chauvinists. Most women doctors are no exception to this, having taken a role of “honorary men.”

(Our Bodies, Ourselves, 1970, p. 187)

I chose one of the two women doctors because I believed a woman would be less likely to push drugs and surgery…In the first visit, she suggested not only thyroid medication but also a routine X-ray; she talked crisply, rapidly, coolly, with many complicated medical terms. I felt as if I were sitting across from a medical school curriculum.

(Our Bodies, Ourselves, 2011, p. 673)

These two quotations show the consistency in messaging about female providers across four decades of the feminist health book, Our Bodies, Ourselves (OBOS): that they approach healthcare just like men. This is a surprising stance for a book that advocated female empowerment through acquisition of bodily knowledge, rhetorically enacting this commitment by juxtaposing women’s testimonies alongside excerpts from medical textbooks (Wells). While critics have recognized OBOS’s limitations, calling attention to the exclusion of women of color, lesbians, and women with disabilities from early editions, few have considered the exclusion of women in healthcare from the text’s collective “we.” Early editions framed the female healthcare worker as opponent rather than collaborator. They constructed the medical field as a “men’s club” and women within it as alienated from their feminine identities. And while the most recent 2011 edition revises pronouns for doctors to present day gender-neutral standards, it still reveals vestiges of an insider/outsider divide that distances readers from women working in healthcare. This divide becomes all the more problematic in an age where women’s decisions about controversial care like vaccines often rely on accounts of bodily experience while villainizing medical professionals.

In this article, I examine framing of female healthcare workers—the “inside women”—in the 1971 edition of OBOS, the 1973 edition that marked its transition to mainstream publisher Simon and Schuster, and the most recent 2011 edition. While previous authors have pointed to the 1984 edition as a key turning point for the collective’s critique of medicine, I show how the 1973 edition’s framework created a basis for that critique (Davis; Wells). In addition, rather than tracking changes from one edition to the next, my project is interested in showing what lingers and unpacking the remarkable consistency that emerges in how the editions treat female healthcare workers; hence, my focus is primarily on the first two publications and the 2011 edition. I draw on frame analysis to help understand this consistency, a methodology based on Erving Goffman’s theory about how events are presented and placed within a field of meaning. Rhetorical frame analysis attends to how discourse impacts the presentations of events, people, or things over time. Specifically, Snow and Benford’s concept of “ideational anchoring” provides a lens for this project and unpacking how “[social] movements that emerge later in the cycle will typically find their framing efforts constrained by the previously elaborated master frame” (212).

Overall, I argue that the most recent edition of OBOS is rhetorically torn between maintaining faithfulness to its original strategies—demonizing doctors and mobilizing a radical feminist movement—and updating its perspective to reflect a medical industry in which women serve as both laborers and patients. The result is a guide that simultaneously discourages cooperation between female healthcare workers and medical consumers, even while it espouses messages of access and collaboration. While critical, my aim is not to discredit OBOS or other women’s health initiatives. By demonstrating how the consistent insider frame of OBOS leads to a mistrust of medical authorities and an overreliance on the experiences of the individual, I can also offer pragmatic implications for those involved in women’s health advocacy and for feminist rhetoricians who study health and medicine. In the discussion, I address connections between OBOS’s framing of female healthcare workers and rhetorics of anti-science to consider both the pitfalls of this framing and potentials for reimagining the position of the “inside woman” within feminist health initiatives (Dubriwny; Scott; Whidden).

The Women’s Health Movement and Feminist Activism 1970-Today

Before delving into an analysis of rhetorical framing across editions of OBOS, it is important to contextualize the book within the shifting landscape of the women’s health movement more broadly from the 1970s to today. The contemporary women’s health movement began as a radical, grassroots initiative that spread techniques for attaining personal embodied knowledge, but with the aim of large-scale institutional and social change. Today, women’s health is a billion-dollar industry that “depict[s] health as both the responsibility and the obligation of individuals and consistently reif[ies] traditional gender roles for women” (Dubriwny 3). Alongside these shifts, the feminist movement has undergone its own ideological transformations, grappling with how to maintain emphasis on foundational concepts like embodiment while accounting for intersectionality and individual choice (Hayden; Fahs).

While women’s health advocacy undoubtedly has a long and varied history, Barbara Seaman’s 1969 book, The Doctors’ Case Against the Pill, is often referenced as a starting point for the second-wave feminist health movement in the United States. Seaman drew on testimony from women about their dangerous health experiences with legal birth control, as well as interviews with physicians and medical researchers to show the limitations of scientific knowledge about the pill (Dubriwny 17). This book, as well as early editions of OBOS, exemplified three modes of storytelling that Sobnosky (2013) describes as key to the rhetoric of the second-wave women’s health movement. Sobnosky argues that women used three modes to (1) link current medical care to biased and unscientific practices of the past, (2) demonstrate how these practices negatively impacted their care through “doctor stories,” and finally, (3) position themselves as the real experts “test[ing] theoretical knowledge against their empirical experience” (219). These narratives relied on tactics of feminist consciousness-raising, which worked to bridge the personal and the political by demonstrating that “what were thought to be personal deficiencies and individual problems are common and shared, a result of their position as women” (K. Campbell 79). They also relied on the unique practices of embodied self-help characteristic of the second-wave feminist women’s health movement, like the vaginal self-exam. In her analysis of this exam, Michelle Murphy describes how a learned process of “producing the evidence of experience” taught women to value and claim their embodied knowledge and to leverage it as evidence for institutional and social change (119).

Indeed, many of the women’s health initiatives emerging in the early 1970s were deeply radical—aiming to overhaul and replace a patriarchal medical system with grassroots women’s health clinics and self-help practices. A project launched by the Boston Women’s Health Collective during the early 70s to provide training to Harvard medical students on performing women-centered pelvic exams exemplifies this trend. After several revisions to the collaboration that gave Collective members exceptional input and leadership in designing and implementing the pelvic exam training, the group proposed a program for only women students based on “reciprocal sharing” (Kline 58). This request was untenable and led to the dissolution of the program, despite its initial widespread support from the university, professors, and students.

However, Roe v. Wade’s passing in 1973 also provided an impetus for cooperation with medical practitioners. Feminist abortion clinics came under federal jurisdiction and were legally required to hire licensed physicians, “typically a white male” (Morgen 127). By 1976, there were approximately fifty women-controlled clinics in the United States (Kline 41). Relationships with physicians in these clinics were tenuous—they faced ridicule and harassment from their colleagues in hospitals and resistance from feminist at the clinics themselves (Morgen 127). Still, the institutionalization of previously feminist women’s health spaces began a trend that would carry steadily through into the 1980s when women’s health centers were “coopted by hospitals and health care systems,” lacking any of the “radical, alternative approach to care for women” that had characterized feminist health centers of the 70s (Bernhard 76). Meanwhile, changing legislation in the 70s provided increasing opportunities for women to access medical education. During this decade, the proportion of women medical students nearly tripled, from 10 percent to nearly 28 percent (Kline 46).

Characterized by “ten uninterrupted years of antifeminist, antiliberal, self-identified conservative presidential administrations,” Katzenstein argues that the 1980s necessitated that feminist movements develop new tactics, specifically “unobtrusive mobilization” (30). Working within institutions like higher education, social services, and medicine, feminists managed a marked growth in gender consciousness during a period of political resistance (Katzenstein 30). Still, there was a growing divide between radical feminist initiatives and liberal women’s health movements that by the 1990s meant the two were facing very different fates. While unified feminist movements declined, the women’s health movement flourished spurred by both a specific focus on issue-based initiatives as well as cooperation with institutional insiders (Baird 15). In fact, the leaders of women’s health organizations were often working professionally in medicine or law and were capable of expressing their demands in “culturally acceptable terms” that appealed to the institutions they sought to change (Baird 18).

Of course, institutional collaboration also came with significant risks of co-optation and loss of political vision. In these contexts, “The conditions for success or even continued existence often undermine[d] feminist goals and processes” (Katzenstein 31). Thus, what looks like a flourishing women’s health movement today—in the form of nationwide campaigns to support breast cancer awareness, research on women’s heart disease, or attention to postpartum depression—has lost many of its connections to feminist aims. Instead, these movements promote a vision of what Dubriwny calls “the vulnerable empowered woman,” who “through her various practices of risk management and consumption, functions to support a variety of neoliberal power structures, ranging from reifying traditional gender roles to supporting certain research agendas over others” (9).

Admittedly, our vision of what feminism and feminist rhetoric entail has changed dramatically in the intervening decades as well. The second-wave feminist focus on individual embodied knowledge as a source of radical political change has come under fire for its naïvity, while women’s studies programs have shifted towards more theoretical and abstract notions of the body (Fahs; Kline). Meanwhile, the idea that all women across cultural, racial, and socio-economic boundaries share essential and universal experiences has also been critiqued, with more recent movements emphasizing the necessity of intersectional approaches and a diversity of perspectives. Some recent rhetorical research has worked to recoup the tactics of second-wave feminist health movements to demonstrate their complexity and contributions to contemporary feminist conversations about individual experience, choice, and institutional change (Fahs; Hayden; Sobnosky). Still, new technology for tracking women’s health demonstrates how radical political acts like the vaginal self-exam can be co-opted into ideologies of self-regulation, as women are asked to enter their cervical position into their fertility apps—one data point among many. With the advent of online health communities and the rise of the e-patient, we face a proliferation of health misinformation that frequently blurs lines between corporate interests and scientific work, between expert knowledge and individual experience. It is in this context, I will argue, that collaboration between feminist health activists and healthcare insiders becomes all the more important. Understanding how and why OBOS maintained its mistrustful stance towards insiders across multiple decades can provide one means for reimagining that relationship in future feminist work.

Rhetorical Frame Analysis of the 1971, 1973, and 2011 editions

While the shifting landscape of the women’s health movement in the 1970s certainly impacted OBOS’ messaging, their move from the radical publisher New England Free Press to mainstream publisher Simon and Schuster in 1973 also played a role. This move was one of the most controversial decisions for the collective, but was born of a desire to reach wider audiences outside feminist organizations and even the women’s health movement (Kline 17). Meanwhile, Musser argues that the book’s move to a larger, mainstream publishing house in 1973 also marked a shift away from collective health goals towards a more essentialist, individual vision: “In the 1973 edition of OBOS, the pull toward a collective identity had been displaced by a desire to foster the growth of the individual” (102). But why did this shift to a more individualist perspective on healthcare also reinforce the alienation of the female healthcare worker? To make sense of this perpetuation of the “insider frame” between the 1971 and 1973 editions, and its continuation in the latest 2011 edition, I turn to rhetorical frame analysis.

Based on Erving Goffman’s 1974 book of the same title, frame analysis was initially developed as a method in Sociology to analyze mobilization of participants in social movements. Sociologists understand framing as “meaning work” and frames are described as “‘schemata of interpretations’ that enable individuals ‘to locate, perceive, identify, and label’ occurrences within their life space and the world at large” (Benford et al., 464). Rhetoricians have since adapted frame analysis to attend to how discursive choices shape the framing of events, people, or things over time. Kuypers (2010) describes a rhetorical methodology that begins by identifying themes that appear in narratives over time and then examines “key words, metaphors, concepts, symbols, visual images, and names given to persons, ideas, and actions” to understand how that theme is being framed (301). His approach resonates with other methodologies, such as Condit’s (1999) tracking of the “rhetorical formations” in discourse on the gene (14). However, frame analysis is particularly apt for this project both because it aligns with a critical feminist orientation and because it offers an analytic vocabulary specifically tied to social movements.

First, Hardin and Whiteside argue that frame analysis is ideally aligned with feminist goals; it enables them to “advocate pragmatic ways that social movement organizations can advance more progressive framing” (315-316). Similarly, my project aims to unpack the processes that caused the ideational anchoring of OBOS’s insider frame with the goal of revealing how part of an organization’s message might remain inconsistent with the greater goals of a movement. In addition, frame analysis provides a language for describing frames that emerge as a social movement seeks to align participant’s perspectives with its own. One method for linking individual perspectives to organizational frameworks is frame amplification, which clarifies and invigorates a previously established frame (Snow et al. 469). Rather than radically altering their mistrustful attitude towards female doctors between the 1971 and 1973 editions, I argue that the authors amplified their perspective of the woman insider.

To make sense of the amplification of this “insider frame,” it is necessary to contextualize it alongside the changing diagnostic, procedural, and motivational frames occurring between the 1971 and 1973 editions. According to Snow and Benford, the diagnostic frame “identif[ies] a problem and [attributes] blame or causality” (200). Meanwhile, prognostic frames “not only suggest solutions to the problem but also identify strategies, tactics, and targets” (201). Finally, the motivational frame is “the elaboration of a call to arms or rationale for action that goes beyond the diagnosis and prognosis” (203). These three components help bring to light the relationship between the amplification of the “insider frame” and OBOS’s vision. Finally, I turn to the 2011 edition, which reveals vestiges of an insider/outsider divide that distances readers from female healthcare workers. Snow and Benford argue that early on in a movement a “master frame” is developed which often remains intact: “provid[ing] ideational or interpretive anchoring for subsequent movements within the cycle” (212). If each edition of OBOS is read as a “movement within a cycle,” then the remains of a mistrustful framing of female healthcare workers in the 2011 edition can be understood as part of an “interpretive anchoring.” Overall, this analysis draws on and adapts frame analysis to better understand the mechanisms of ideational anchoring and the interactions between an anchored frame and other central frames in a text.

Diagnostic Framing in 1971 and 1973: Blaming the Doctors

Both editions of OBOS begin with a similar diagnostic account of the “problem” that prompted the book: bad doctors. Ultimately, doctors are described as personifying the more comprehensive institutional problems in healthcare. The doctor is a natural scapegoat—often white, male, and upper-class he embodies the institutional forces at work in maintaining the status quo and is often the face that accompanies the collective’s medical experiences. Thus, the diagnostic task of OBOS in both 1971 and 1973 involves identifying patriarchy and capitalism as causes for the inadequate health system in America and subsequently “blaming” the doctor for those problems. In order to link the doctor to an overarching patriarchal system, the authors eliminate female healthcare workers from their narrative through the use of male pronouns, parallelism between male problems and doctor problems, and causal links between patriarchal doctors and sexist medical institutions.

First, the authors consistently use the male pronoun “he” when discussing doctors, associating the profession with masculinity. Some may argue that attending to male pronoun use for books published in the 1970s is problematic, since the use of “he” as gender-neutral was so widespread at the time. Still, linguistic studies have shown that readers’ interpretations of a text are directly affected by gendered pronouns. Miller (1994) reports that “women tend to avoid responding to job advertisements containing generic he, because they feel that they do not meet the qualifications outlined in the ads” (269). In addition, in 1970 7.6 percent of physicians were female, so the male pronoun did represent the vast majority of doctors (Kline 14). Thus, female readers were already unlikely to associate themselves with the doctor’s role. The use of the masculine pronoun then served to augment this disassociation and to position them in opposition to the “masculinized” women who did take on roles as health practitioners.

In addition, the problems with doctors are often conflated with problems of masculinity, in both editions, so that the masculine pronoun is necessary for the logic of the collective’s arguments. For example, the 1971 edition accuses “doctors” of a lack of knowledge about female sexuality: “Doctors in general are as ignorant about sexuality as the rest of the men in society” (135). Here, “doctors” are equated with men, and to read “doctors” as meaning both male and female would make the sentence  illogical. Similarly, the 1973 edition describes defensive men using psychological diagnosis as a weapon against female patients: “In a strange way, a doctor often feels personally attacked or threatened when he cannot find any physical cause for the symptoms you report, and this can cause him to become hostile and use a label of ‘neurotic’ or ‘psychosomatic’ as a weapon” (246). Again, while one could read the “he” here as gender-neutral, one would miss the larger argument being made about the patriarchal construction of the hysterical woman as indicative of male ignorance. A number of metaphors in the two editions also emphasize the parallels between doctors’ and men’s weaknesses. For example, connections are drawn between medical training and a fraternity rush (1971, 6) or the priesthood (1971, 129). Meanwhile, the 1973 edition discusses women’s instinct to equate the doctor role with a father role and cautions against it (250). In these ways, doctors’ weaknesses are tied specifically to men’s limitations solidifying their masculine positioning.

Finally, both editions articulate a causal link between the patriarchal doctor and the oppressive healthcare system. The 1971 edition uses an excerpt from Fortune magazine to put the faults of the medical system on the doctor’s shoulders: “Fortune magazine says: ‘The doctors created the system. They run it. And they are the most formidable obstacle to its improvement” (182). Here, doctors are both “obstacles” and decision-makers, controlling the fate of consumers in numerous areas of medical access. The 1973 edition features a nearly identical attribution of blame, although Fortune magazine is removed as a source, with the authors taking ownership of the sentiment: “The American doctor has claimed for himself unusually broad powers. It is he who decides which patients are treated and where, the cost of treatment, who goes to the hospital, which treatment is given and for how long” (240). Interestingly, the 1973 edition removes the language of a “system,” instead speaking of “unusually broad powers,” which the American doctor actively claims. This portrays each American doctor as taking part in claiming power, rather than participating in an oppressive system that was created before them.

Overall, then, the diagnostic frame remains consistent across the two early editions of OBOS: the doctor is the scapegoat, a face for the institutional problems of the medical industry. Meanwhile, his masculinity is fundamental to occupying that position. However, the 1973 edition diverges from the 1971 edition by providing far more elaboration on why the “inside woman” could not be an active participant in the women’s health movement. This is directly related to the larger frame shift from a collectivist project in 1971 to an essentialized understanding of all Women as already unified in 1973.

Prognostic and Motivational Framing in 1971 and 1973: From Collective to Individual

In general, the 1971 and 1973 editions share a prognostic frame as well. To counter patriarchal doctors and an oppressive healthcare system the authors encourage women to gain self-understanding of both their minds and bodies. Learning about one’s body is the fundamental strategy and tool that undergirds both editions. However, because of a shifting understanding of their audience, there are also distinctions in how the two editions view that process of self-understanding contributing to the creation of a feminist collective (their motivational frames). The 1971 edition argues that all women are coming from a position of alienation to their bodies and thus, need education about those bodies in order to become a collective and overhaul the system. Meanwhile, the 1973 edition still speaks to women’s lack of bodily understanding, but also assumes an already existing bond between all Women. Its motivational frame, then, is focused on informing individual consumers rather than motivating a revolutionary collective. While Davis attributes the shift away from collective transformation to individual action to the 1984 edition, this analysis shows the origins of this shift appear much earlier in revisions between the 1971 and 1973 editions.

Setting out its prognostic frame, the 1971 edition outlined a number of steps that must be taken for women to become part of a successful feminist collective: “First, subjectivity had to be composed of both the body and the mind. Second, the particularly female body had to be redeemed from its debased status. These things taken together allowed for the third, the formation of female bond and ultimately feminist collectives political female social bodies” (Musser 96). Along these lines, then, the authors in 1971 edition describe their initial alienation from their bodies and reaction to the bodies of other women as an experience that is mediated through the male gaze: “Every part of our body is an area of real or potential disgust to us…And the objectified disgust we have for ourselves we feel towards other women” (9). All women, then, are in need of an education that will allow them to remove the male gaze from themselves and others. Thus, when the authors go on to casually mention female doctors as “having taken a role of ‘honorary men’” (186), this does not prove particularly surprising. After all, patriarchal society has caused all women to objectify one another and be disgusted with their own bodies; female doctors naturally share in these prejudices.

Meanwhile, the motivational frame of the 1971 edition was visible even through its layout: it is book-ended by two chapters that address the patriarchal and capitalist forces at work in medicine, contextualizing all of the informative chapters within a movement to revolutionize healthcare. In both chapters, justice in healthcare is depicted as only possible outside of the current system: “We will gain nothing by pumping more money into our present system. Healthcare for everyone is possible only outside of the profit system” (191). Thus, learning more about one’s own body is part of a larger process in becoming a member of a feminist collective and enacting revolution. To stop at self-help is to understand the strategies (prognostic frame) being articulated in the 1971 edition, but to miss the call to arms (motivational frame).

The 1973 edition, in contrast, proposed similar methods for developing bodily understanding, but assumed an already unified female readership: “Since one was already taken to be a member of the community of women, one did not become a woman/subject in the same way as in the 1971 edition, but rather one was informed” (Musser 102). This was part of their broader shift to a motivational frame that focused on being informed rather than systemic overhaul. The 1973 edition allocates all of the information about systemic injustice to a final chapter entitled “The Women’s Health Movement.” Even this is a deceiving title, since the chapter focuses primarily on practical advice for receiving the best possible treatment in the current medical system. The authors optimistically suggest the potential of systemic change but also assert that these changes are already in progress:

Lots of changes are coming…but for most of us for a long time doctors and hospitals as they are now will be part of our lives. Just being enraged with the system shouldn’t keep us from trying to the very best medical care that money can buy right now, for the very least we can pay, whenever we need it.


This articulation is sharply juxtaposed to the call not to “pump more money into our present system” in the 1971 edition and followed by concrete advise on mediating interactions with doctors and medical staff and gaining access to insurance benefits and treatment. Ultimately, rather than overthrow the system, the revised OBOS helps readers “to negotiate the system instead of allowing the system to negotiate you” (269).

However, for the 1973 edition, the idea of an existing bond between women proves problematic in the case of female healthcare workers alongside the consistent diagnostic frame that identifies all doctors as patriarchal: could someone be a doctor and thus responsible for the capitalist and patriarchal medical system as well as a Woman? In response, the authors amplify the insider frame, highlighting the masculinity and self-alienation of the female healthcare worker to address this discrepancy.

Amplifying the Insider Frame from 1971 to 1973

With these shifting prognostic and motivational frames also comes a shifting relationship to female healthcare workers. In the 1971 edition, the potential for the reader to develop a new relationship to her body also leaves open the potential for the female doctor to do the same, to come to understand herself and other women through participation in a feminist collective. The authors discuss their previous cooperation with insiders in the medical field in the introduction to the text and also envision future cooperation as part of the process of overturning the current healthcare system. Meanwhile, the 1973 edition takes the initial accusation that female doctors are “honorary men” and amplifies it, emphasizing the masculinity of the workers and arguing that medical training has inducted them into the patriarchy.

The 1973 edition amplifies the masculinity of female healthcare workers through both descriptions of their training and by separating them from the book’s collective “we.” The authors discuss how female doctors overcame prejudice in medical school: “They had to ‘outman the men,’ so to speak—to be more conservative, more rigid, ‘better’ in every way than their male colleagues, or even renounce the mother-wife role altogether, just to survive” (350). Hyper-masculinity is viewed as necessary over-compensation for the inside woman. In addition, the Collective makes rhetorical moves to separate female doctors from themselves and their readers. Female doctors are not seen as mothers or wives, and, therefore, just like a male doctor, they cannot understand “women’s issues” of pregnancy, birth control, or sexuality. To further this separation, the 1973 edition also suggests that the female doctor might be sexually repressed: “It has also been suggested that as women they had problems with their sexuality, and perhaps…they did, having absorbed so much contempt for their sex from doctors and from society and yet still wanting to be doctors” (350). In the 1973 edition, alienation from her body is not a shared trait of the unenlightened woman like it was in the 1971 version, but a further mark of estrangement for the female healthcare worker. The “and yet still wanting to be doctors” comment suggests that a continued desire to stay in medicine is evidence of one’s acceptance of a patriarchal perspective.

That said, the 1973 edition does discuss the potential for new women doctors who are coming out of the feminist movement to be more resistant towards the patriarchal medical institution but these female doctors are still not a part of the collective “we” of OBOS. The book suggests that some of these doctors have similar goals to the women’s health movement generally: “Many of these women are deeply interested in community medicine and family practice…Some hope to be able to improve medical care for women and families, and will be looking for communities in which to do this work” (241). However, the use of “these women” and “some” separates female doctors from the movement rhetorically, highlighting again the notion that female doctors are not part of a shared feminine subjectivity. Later on, the authors become altogether dismissive of any course offered by a medical professional: “Courses taught by people who are part of the ‘health’ system have rarely given really honest consumer information…Only when health education is based in the community and run by the community will women be able to get truthful information” (270). Even “these women” who want to work in community medicine are not to be trusted, coming from within the system. The authors invalidate both their ability to participate in sharing female experience and the legitimacy of their information. In examining the 1973 edition’s positioning of female healthcare workers, then, one can see how the amplified insider frame expanded on their masculinity to align them with a patriarchal system and repeatedly distanced them from the readers of OBOS and its feminist health project.

The 2011 Edition: Ideational Anchoring of the “Insider Frame”

Given the changing landscape of healthcare in the nearly forty years that separate the 1973 edition of OBOS and the 2011 edition, one might expect the newest edition to offer a transformed “insider frame” that reimagines female healthcare workers as part of the book’s collective “we.” Indeed, the authors acknowledge the large population of female insiders in healthcare: “Women are now more often healthcare professionals (accounting for 49 percent of medical school graduates in 2007, compared with 9 percent in 1970)” (759). In fact, beginning with the 2005 edition, healthcare practitioners contributed to the text, included among a group of 400 external contributors that also involved journalists and administrators” (Davis 40). In addition, beginning with the 1998 edition, OBOS authors hired voice and tone editors to ensure that the book best spoke to its diverse readership. Among the considerations for these authors were racial differences, disability issues, sexual orientation, and religious background (Bonilla). While healthcare practitioners were not explicitly identified as a diverse group, grammatical changes reveal that the book is responding to the changing role of women in medicine. Doctors are primarily referred to as “healthcare providers/professionals” and the authors now employ multiple pronouns to demonstrate gender flexibility in the profession. Bonilla specifically describes how part of her work as voice and tone editor of the 2005 edition was to “acknowledge the many individual women, advocates, and families who have learned to fight the medical-zation of women’s bodies from inside the medical establishment” (181).

Still, the tentative relationship to female healthcare workers that began back in the early editions remains anchored in the newest edition. As they reassign blame to the more abstract agent of the “United States” and articulate models for self-education that might involve collaboration with healthcare insiders, the authors of the newest edition face what Benford and Snow describe as “dilemmic contradictions.” These contradictions emerge as a result of an anchored frame that no longer aligns with the larger views of an organization. The authors resolve these contradictions, in part, through a turn to technological innovations at the end of the edition, presenting a vision for feminist health movements that positions the Internet as a radical space where non-experts can share information and mobilize. In this way, they still look towards a future where change can happen without collaboration with female insiders.

In constructing their diagnostic framework, the authors of the 2011 edition have shifted the blame from doctors and healthcare workers to politicians and the United States’ government. Wells traces this shift to the 1984 edition when she argues the focus on the doctor as scapegoat no longer held political resonance: “They had begun by investigating the individual doctor-patient relationship and criticizing its power relationships; in 1984, they confronted medicine as a corporate practice that posed questions of access to care” (13). In the 2011 edition, Chapter 26 is entitled “The Politics of Women’s Health” and begins with a discussion of how the widening economic gap that was a result of the Reagan and Bush administrations has negatively impacted access to healthcare across the country. The primary agent of blame in this section is the “United States.” The “United States” is useful as an agent since it descriptively encompasses a range of injustices and systemic forces, allowing the authors to make sweeping statements such as: “The United States does not ensure access to healthcare and related services” (651). At the same time, opposing this agent and all of the various forces involved in its agency is nearly impossible to imagine. Instead, this diagnostic frame offers the potential for only individualized, small-scale interventions, often focused on acquisition of knowledge.

Meanwhile, the prognostic frame of the 2011 edition does envision a degree of cooperation with healthcare providers in the process of gaining more knowledge about personal health. The authors address groups and classes that are run by “physicians, medical centers, and hospitals” and “emphasize self-care and activities that we can do to manage our care in conjunction with our providers” (659). Still, they urge readers that when it comes to “self-help groups,” it is only without the presence of institutional insiders that real interrogation of the system can occur: “When these groups are independent of healthcare institutions and professionals, we can freely question, challenge, and evaluate accepted medical treatments and explore nonmedical therapies and providers” (659). As Snow and Benford argue, the perpetuation of the “master frame” can often lead to “dilemmic contradictions” in a text and here we see those contradictions at work. The authors want to acknowledge the productive potential of expert-lead groups, but still feel that the most productive knowledge building can only occur outside of institutional contexts because of their book’s ties to feminist consciousness-raising.

Similar contradictions appear in explicit discussions of female healthcare workers in the 2011 edition, where the ambivalence of the authors towards female insiders is made clear. The book references research that finds female healthcare workers tend to be more in-line with feminist health practices: “Studies have found that female physicians spend more of the visit on preventive care…and patients of female physicians report higher satisfaction with their care” (673). Yet, at the same time the authors urge readers not to choose practitioners based on gender, since all doctors emerge from the same training programs: “Unfortunately, female physicians emerge from the same stressful and dehumanizing medical training process that affects all doctors” (673). Here, the author’s have switched from a view of medical training as “de-feminizing,” removing the potential for female healthcare workers to be in touch with their female sexuality, to “dehumanizing.” This is in line with the abstracting work of the diagnostic frame, which removes human agents by giving action to a system.

The mistrustful positioning towards the female healthcare worker as a result of this dehumanizing education remains the same, however. For example, the 2011 edition shares an anecdote from a patient who chose a woman doctor and was appalled when: “In the first visit, she suggested not only thyroid medication but also a routine X-ray; she talked crisply, rapidly, coolly, with many complicated medical terms. I felt as if I were sitting across from a medical school curriculum” (673). While female healthcare workers are no longer described as paternalistic or hyper-masculine, the authors of the 2011 edition still highlight their participation in a medical school system that alienates them from personal, woman-centered care. Even in the case of alternative female practitioners, the 2011 edition emphasizes emergence from a “system” that is not aligned with feminist ideals for health practice. The authors acknowledge that when it comes to nurse practitioners and midwives, institutional training may lead to better care but add the caveat that “they often learn in a hierarchical learning model similar to that for physicians and face some of the same constraints as physicians” (673). Thus, even as they describe a range of healthcare providers, they align alternative practitioners with more mainstream caregivers through discussions of their training and thus, take a mistrustful stance towards them.

The 2011 edition does break from the 1973 edition, in that it uses technology and access to information on the Internet as the means for a new motivational frame that emphasizes the potential for anyone to intervene in spreading health knowledge. Chapter 27, the last in the 2011 edition, is entitled “Activism in the 21st Century” and optimistically imagines a world in which readers can share information and become part of international health movements using the Internet. In keeping with the larger vision of the book, this chapter emphasizes the non-expert status of members in these online communities: “In this new era, traditional gatekeepers have been replaced by a decentralized assembly of digitally empowered citizen journalists” (810). These “citizen journalists” have the potential to counter mainstream medical information and challenge the doctors and pharmaceutical companies that spread misinformation. In addition, it is easier than ever to form groups without the guidance of experts in the field: “Organizing does not take experts or a lot of money. What it does take is a committed group of individuals willing to invest time and energy to work together towards a common goal” (810). Thus, the Internet has reinvigorated OBOS’s motivational frame, providing a new platform for collective action. At the same time, their mistrustful stance towards female insiders remains in tact. Ultimately, this view of the productive potential of non-expert online spaces has been significantly called into question by recent developments in online health discourse, like the anti-vaccination movement, as I consider in the next section.

Overall, while the frames OBOS authors used to describe female subjectivity, blame individuals or institutions, and suggest potential venues for action have all responded contextually to historical changes over the past three decades, the treatment of the “insider woman” has remained ideationally anchored. Its anchoring, despite the shifting relationship between female insiders and outsiders in the women’s health movement generally, leads the authors to a motivational frame in 2011 that encourages grassroots action but does not imagine successful cooperation with women inside the medical institution.

Looking Forward: Directions for Activist-Expert Collaboration

Reflecting on how the critical lens of science studies has been taken up by anti-science organizations to argue against climate change, pre-eminent science studies scholar Bruno Latour notes: “a certain form of critical spirit has sent us down the wrong path, encouraging us to fight the wrong enemies and, worst of all, to be considered as friends by the wrong sort of allies” (231). In a similar way, second-wave feminist critiques of medical institutions have provided a rhetorical foundation for radical anti-science movements such as the anti-vaxers. Here, I consider anti-science movements’ appropriation of arguments about bodily expertise and antagonistic stance towards expert insiders. Then, I discuss existing models for activist-expert collaboration as future directions for feminist health movements and feminist rhetoricians.

Like the authors of OBOS, much anti-vaccination rhetoric that circulates in online forums relies on the evidence of women’s bodily expertise—particularly their motherly intuition—to counter scientific claims about health. Whidden (2012) describes the MMR-autism controversy: “a number of celebrities join other mothers to advance the idea that a mother’s personal experience with her child is stronger evidence than research validated by the standards of the technical sphere” (251). Similarly, Scott (2016) notes how Jenny McCarthy’s account describes her son as “her science” in her book about autism: “exemplifying the way that the observations and experiences of parents are constructed as scientific evidence” (67). Of course, this is not merely a replication of feminist health rhetorics. OBOS was radical in part because of its willingness to engage directly with scientific sources like medical textbooks and put these sources in conversation with women’s embodied experiences (Wells). Rather than simply repeating or validating a single experience or perspective, the juxtaposition of accounts in OBOS created a cacophony of different perspectives. As Hayden (2018) explains, “[the authors] acknowledge that their perspectives are partial and they seek out the opinions of others, including those whose experiences differ from their own and with whom they disagree. The result is a text replete with contradictions” (241). And yet, my analysis has also shown that even if there was variation in how women’s experiences were described in OBOS, there was also consistency across many decades in OBOS’s orientation towards female insiders. We can see the spirit of this skepticism of and resistance towards health “experts” replicated in the rhetorics of anti-science movements in ways that suggest a need for reimagining the relationship between feminist health movements and mainstream practitioners.

Just as the current edition of OBOS envisions online spaces as radical places to continue the work of feminist health movements, these spaces can also create opportunities for more interaction between experts and lay-people. Bakke (2018) offers one model for this kind of collaboration in her examination of a Parkinson’s discussion forum that includes a physician moderator. She notes how the moderator facilitated trust with the forum participants “as he interacted and empathized with members” (3). Meanwhile, Dubriwny provides a vision for feminist health activism to act as a “watchdog of biomedicine” on a larger scale with the example of the grassroots organization Breast Cancer Awareness (BCA), which takes on “an activist orientation that exists both alongside and in opposition to biomedicine” (157). Through activities like testifying at FDA hearings and gathering their large-scale evidence through online surveys of women, BCA participants frequently read scientific research and engage directly in expert conversations rather than rejecting scientific work. These modes of engagement create opportunities to align themselves with like-minded health practitioners rather than taking an antagonistic stance towards anyone involved in healthcare practice.

Meanwhile, the call for more cooperation with healthcare insiders extends to feminist rhetoricians of health and medicine as well. As Reed (2018) and Campbell (2018) have noted, research in the rhetoric of health and medicine has frequently taken a critical stance towards health practitioners and researchers, aligning themselves with the patient’s embodied experiences that so often go unheard. However, there are many risks inherent in calling for more collaboration between activists and healthcare insiders, from abdicating responsibility for medical monitoring and responsibility to patients (Kopelson 357) to corporate appropriation of personal discourses of embodiment (Whidden 246). Thus, feminist rhetoricians have much to contribute in reimagining productive modes of engagement between disparate groups with varying levels of expertise while also looking out for slippages that disadvantage the patient. However if, like the authors of OBOS, we consistently prioritize the embodied experiences of patients and alienate the experts, we run the risk of replicating the kinds of logic that have fueled anti-science movements rather than contributing to a future vision for productive collaboration with science experts. Thus, looking forward, it is imperative for both feminist health movements and feminist rhetoricians of health and medicine to consider how expert-activist cooperation might be accommodated in our rhetorical frames in innovative and revolutionary ways.

Works Cited

Baird, Karen L. “Introduction—Beyond Reproduction: The Women’s Health Movement of the 1990s.” Beyond Reproduction: Women’s Health, Activism, and Public Policy, edited by Karen Baird, Dana-Ain Davis, and Kimberly Christensen, Fairleigh Dickinson University Press, 2009, pp. 9-34.

Bakke, Abigail. “Trust-Building in a Patient Forum: The Interplay of Professional and Personal Expertise.” Journal of Technical Writing and Communication, Online First, 2018.

Bernhard, Linda A. “Women’s Health Nurse Practitioners, Feminism, and Women’s Studies.” Women’s Studies Quarterly, vol. 31, no. 1/2, 2003, pp. 76-89.

Bonilla, Zobeida E. “Including Every Woman: The All-Embracing ‘We’ of ‘Our Bodies, Ourselves’”. NWSA Journal, 2005, pp. 175-183.

Campbell, Karlyn Kohrs. “The Rhetoric of Women’s Liberation: An Oxymoron.” Quarterly Journal of Speech, vol. 59, no. 1, 1973, pp. 74-86.

Campbell, Lillian. “The Rhetoric of Health and Medicine as a ‘Teaching Subject’: Lessons from the Medical Humanities and Simulation Pedagogy.” Technical Communication Quarterly, vol. 27, no. 1, 2018, pp. 7-20.

Condit, Celeste Michelle. The Meanings of the Gene: Public Debates about Human Heredity. University of Wisconsin Press, 1999.

Davis, Kathy. The Making of Our Bodies, Ourselves: How Feminism Travels Across Borders. Duke University Press, 2007.

Dubriwny, Tasha N. The Vulnerable Empowered Woman: Feminism, Postfeminism, and Women’s Health. Rutgers University Press, 2012.

Fahs, Breanne. “The Body in Revolt: The Impact and Legacy of Second Wave Corporeal Embodiment.” Journal of Social Issues, vol. 71, no. 2, 2015, pp. 386-401.

Hardin, Marie and Erin Whiteside. “Framing through a Feminist Lens: A Tool in Support of an Activist Research Agenda.” Doing News Framing Analysis: Empirical and Theoretical Perspectives, edited by Paul D’Angelo. Taylor & Francis, 2010, pp. 312-330.

Hayden, Sara. “Toward a Collective Rhetoric Rooted in Choice: Consciousness raising in the Boston Women Health Book Collective’s Ourselves and Our Children.” Quarterly Journal of Speech, vol. 104, no. 3, 2018, pp. 235-256.

Katzenstein, Mary Fainsod. “Feminism within American Institutions: Unobtrusive Mobilization in the 1980s.” Signs, vol. 16, no. 1, 1990, pp. 27-54. 

Kline, Wendy. Bodies of Knowledge: Sexuality, Reproduction, and Women’s Health in the Second Wave. University of Chicago Press, 2010.

Kopelson, Karen. “Writing Patients’ Wrongs: The Rhetoric and Reality of Information Age Medicine.” JAC, vol. 29, no. 1/2, 2009, pp. 353-404.

Kuypers, Jim. “Framing Analysis from a Rhetorical Perspective.” Doing News Framing Analysis: Empirical and Theoretical Perspectives, edited by Paul D’Angelo and Jim Kuypers. Taylor & Francis, 2010, pp. 286-311.

Latour, Bruno. “Why Has Critique Run Out of Steam? From Matters of Fact to Matters of Concern.” Critical inquiry, vol. 30, no. 2, 2004, pp. 225-248.

Miller, Cristanne. “Who Says What to Whom?: Empirical Studies of Language and Gender.” The Women and Language Debate: A Sourcebook, edited by Camille Roman, Suzanne Juhasz, and Cristanne Miller. Rutgers University Press, 1994, pp. 265-279.

Morgen, Sandra. “The Changer and the Changed.” Into Our Hands: The Women’s Health Movement in the United States, 1969-1990. Rutgers University Press, 2002, pp. 120-153.

Murphy, Michelle. “Immodest Witnessing: The Epistemology of Vaginal Self-examination in the US Feminist Self-help Movement.” Feminist Studies, vol. 30, no. 1, 2004, pp. 115-147.

Musser, Amber Jamilla. “From Our Body to Yourselves: The Boston Women’s Health Book Collective and Changing Notions of Subjectivity, 1969-1973.” Women’s Studies Quarterly, vol. 35, no. 1/2, 2007, pp. 93-109.

Our Bodies, Ourselves: A Course by and for Women. New England Free Press, 1971.

Our Bodies, Ourselves: A Book by and for Women. Simon and Schuster, 1973.

Our Bodies, Ourselves. Simon and Schuster, 2011.

Reed, Amy R. “Building on Bibliography: Toward Useful Categorization of Research in Rhetorics of Health and Medicine.” Journal of Technical Writing and Communication, vol. 48, no. 2, 2018, pp. 175-198.

Scott, Jennifer B. “Boundary Work and the Construction of Scientific Authority in the Vaccines-Autism Controversy.” Journal of Technical Writing and Communication, vol. 46, no. 1, 2016, pp. 59-82.

Snow, David A., et al. “Frame Alignment Processes, Micromobilization, and Movement Participation.” American Sociological Review, vol. 51, no. 4, 1986, pp. 464-81.

Snow, David A. and Robert D. Benford. “Ideology, Frame Resonance, and Participant Mobilization.” International Social Movement Research, vol. 1, no. 1, 1988, pp. 197-218.

Sobnosky, Matthew J. “Experience, Testimony, and the Women’s Health Movement.” Women’s Studies in Communication, vol. 36, no. 3, 2013, pp. 217-242.

Steinberg, Mark. “Tilting the Frame: Considerations on Collective Action Framing from Discursive Turn.” Theory and Society, vol. 27, no. 6, 1998, pp. 845-872. 

Wells, Susan. Our Bodies, Ourselves and the Work of Writing. Stanford University Press, 2010.

Whidden, Rachel A. “Maternal Expertise, Vaccination Recommendations, and the Complexity of Argument Spheres.” Argumentation and Advocacy, vol. 48, no. 4, 2012, pp. 243-257.

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Clinical Relationships and Feminist Values: How OBOS Benefits Collaborative Relationships in Women’s Health

[D]octors insulate themselves from the rest of society by making the education process (indoctrination) so long, tedious, and grueling that the public has come to believe that one must be superhuman to survive it. (Actually, it is like one long fraternity “rush” after which you’ve made it and can do what you like. Only members of the club get to learn the secret, which is that doctors don’t know much to begin with and are bluffing a good deal of time.) Thus, a small medical elite preserves its own position through mystification, buttressed by symbolic dress, language, and education.

(Candib, 1970)

At a workshop on “Women and Their Bodies,” we discovered that every one of us had a “doctor story,” that we had all experienced feelings of frustration and anger toward the medical maze in general, and toward those doctors who were condescending, paternalistic, judgmental, and uninformative in particular. As we talked and shared our experiences, we realized just how much we had to learn about our bodies, that simply finding a “good doctor” was not the solution to whatever problems we might have.

(OBOS Founders, Judy Norsigian)


In order to understand both the creation of Our Bodies, Ourselves (OBOS) and its impact on contemporary women’s health issues, this project develops two research threads, both focused on understanding collaboration and agency within clinical relationships. Beginning with the women writing OBOS, who took their personal stories and built them into recipes for action, we wanted to understand how OBOS was empowering to both the founders creating it and the women reading it for decades to come.

In writing OBOS, the women of the Boston Women’s Health Book Collective (BWHBC) created a living document, which transformed collaboration and agency within women’s health: medicine for women and by women. In this article, we take up the question: to what extent are these values of collaboration and agency enacted today in women’s health clinical practices? To answer that question, we integrate two research threads. In the first, we begin with an investigation into the archives of the BWHBC: the files of the women who ultimately created OBOS. We articulate how they created a new way of engaging health information for women. But in addition, the members of BWHBC utilized a methodology for engaging interdisciplinary work, allowing for both collaborative and individual goals to be expressed. In the second thread of our research, we interviewed women and clinicians on their working collaborations around birth. We conclude that the work started by OBOS, although not finalized, continues in modern birth practices and relationships.

Because OBOS was premised on a desire to empower women in clinical encounters and asked for women to encourage other women to work together/collaborate, we focus on the themes of both collaboration and agency. The women of BWHBC decided to work together towards shared goals. Interestingly, women when using contemporary OB/GYN services also speak of working with their clinical partners, articulating the goals of a “successful” birth experience. This work echoes the models of shared, collaborative expertise, which is part of the OBOS framework. In this way, OBOS opened up new spaces for women to participate in their overall health experiences, and in birth experiences specifically. We draw heavily upon the rhetorical concepts of critical imagination and social circulation, drawing new connections between the work of developing OBOS, and the resonance in contemporary doctor-patient relationships created for successful birth experiences (Royster, 2012). The power of OBOS resonating today is more than language or a mindset, “[m]embers developed ways of speaking their own embodied experience and of bracketing that experience as partial and local” (Wells 2008: 698). Wells helps us to see that OBOS is more than a medical teaching text—through the text, OBOS articulates new possible agency, both for clinicians seeking to center women in their care, and for women as active agents in their own health decisions. OBOS created such space by “creating vocabulary in which women could talk about their bodies, forging discursive styles and modes of argument, and inventing narrative forms that, but by building authority and solidarity, could establish health work as a field of practice for the women’s movement” (Wells, 2008, p. 698). We show how these textual foundations have received uptake in modern clinical practices.

The Writing of OBOS and Its Legacy

The women of the BWHBC came together to address problems in clinical medicine, long before they wrote—even planned to write—OBOS. The women of BWHBC were riding the waves of important changes from the 1960’s: the women’s movement, health technologies like the pill and IUD, which separated sex from reproduction. But today, it’s often difficult to put ourselves in those moments. It’s important to remember that BWHBC were meeting before the legalization of abortion, and decades before the internet brought health information to the tips of our fingers. In fact, access to health information—including women’s health, specifically—has come to be so easily accessible, OBOS will no longer be updated.

In this same period of writing, medicine itself was coming under greater scrutiny and critique. Academics were crystalizing the language to articulate what many women were experiencing within interactions with healthcare providers. “Medicalization” is often the theoretical lens describing how non-medical problems become taken up as medical problems, or problems that only clinicians can speak clearly about (Conrad). Feminist scholars have since argued that medicalization impacts women, people of color, and queer folks more frequently and with greater damage (Brubaker; Conrad and Angell; DeCoster; Garry; Halfmann; Riessman). Here, the creation of OBOS was a response to these medicalized systems.

Yet OBOS as a creative response did not aim to reject medicine, given that women needed the real benefits of healthcare systems. Instead, OBOS became a novel how-to manual for women as patients, but a new kind of patient: one who took a kind of control and agency over her own health, rather than leaving it to experts. Through the text, women were informed about their own bodies, a revolutionary tool. OBOS did not aim for women to become medical experts, independent of physicians. Instead, OBOS was to be a tool to improve the interactions between both women (as patients) and clinicians. Meant to be read by both ‘sides’ of the clinical relationship, OBOS reflected on the specific health needs, challenges, and responses needed to care for women, working to create “women’s health” as a new domain of study. OBOS drew from clinical research, making it accessible to women, allowing women to be active participants in their own health matters. But it also drew from non-biological determinants of health, clarifying for both women and physicians how social dimensions of health and the social situatedness of clinical responses were necessary in understanding overall health. While putting medical information into women’s hands was itself a political move, OBOS also wove the political into discussions of women’s health, rather than seeing these as separable aspects.

From today’s perspective, it is often a challenge to remind ourselves of what women’s health resources looked like prior to OBOS, and to articulate how this text shaped current clinical interactions. Resistance requires a kind of imagination, and OBOS was the product of the thoughtful and imaginative response of the BWHBC. These authors articulated new possibilities, new solutions, and new interactions for women with their physicians, and these goals are seen in today’s contemporary doctor-patient relationships as we navigate medical systems. Additionally, these women articulated ways of knowing themselves and their bodies that provided space for women’s agency to be an “equal knower” in a clinical space. In this project, we argue that the creative work of the women of the BWHBC has, in many ways, been given uptake, although it has not provided final solutions for women, especially those navigating their first birth experiences. Instead, OBOS has provided a model for an ongoing re-examining of the doctor-patient relationship, one that benefits women to allow for uptake in everyday life. “This is why uptake matters; uptake is relevant to the study and teaching of genre performance maintenance, and change and uptake compels us to pay attention to the historical-material conditions that shape genre performances” (Bawarshi 2012).

Reflected in the legacy of OBOS is the creation of both women as lay-individuals thinking about medicine and collaborative relationships as patients. These new engagements with medicine are connected and re-inscribed activities, what Emmons describes as “uptake.” For Emmons, uptake is the “bidirectional relation” that holds between genres or concepts (Emmons, 2009: 92). In the pre-OBOS writings—Women and Their Bodies: A Course—we see the textual connections that show how outsider/insider status works within medicine. As Candib writes on the first page, in early OBOS work, clinicians were seen by patients as “other” and elite—superhuman, fraternity members, or knowers of secrets. But this description is the beginning place for clinical relationships according to the BWHBC authors. “OBOS was a grand public telling of secrets. The collective raided medical libraries to collect the secrets of physicians and told them shamelessly: they demonstrated how doctors dismissed women’s problems and maintained their ignorance of women’s bodies…The collective insisted that these narratives were not just private matters, that they were not to be confined to either the consulting room or the kitchen table. They opened the public sphere to new issues and new agents…” (Wells, 2010, p. 55). Through the popular distribution of OBOS, women and clinicians found new language to think about women as they engaged them as health care consumers. Below, we explore this in two moments: the meetings to write OBOS, and modern clinical engagements of women with OB/GYNs.

Our Location as Authors

Our engagement with rhetoric theory as a tool for our analysis comes from the side, rather than straightforward as scholars of rhetoric. Given the themes of our paper, including the complex personal and professional interactions of the BWHBC and modern-day health care for childbirth, we want to take a moment to describe our own backgrounds and locations as researchers. Much like the members of BWHBC, we began this work as an interdisciplinary project grounded in shared academic curiosity. While we are both teaching at a health sciences school, our disciplinary homes and methods are rather different. Parker’s disciplinary home is in medical sociology, with a focus on health concerns for women and children. DeCoster is trained as a philosopher, with a focus on how gender and sexuality impact bioethics analysis and health improvement possibilities. Methods diverged: Parker’s empirical leanings means she relies on data; DeCoster’s normative methodology rarely relies on it. Our campus leans to the conservative end of the spectrum, and lab-based sciences are the most visible disciplines. While we were not the only folks who identify as “feminists”, frankly our feminist allies are limited. It also became clear that we were both teaching using feminist theory, and our collaborative connections began in those shared interests and shared language from our feminist training. This gave us a common location to work past seeing disciplinary differences and assumptions as barriers. Instead, this shared space gave us the foundation to work towards trust (not skepticism) of our disciplinary differences. We were able to eventually, with moments of interest, of humor, and frustration, develop this project.

We are interested in how the text of OBOS developed themes that have ripple effects on contemporary health care practice. As Wells (2010) writes, “As a rhetorician, I am as interested in how texts work as in what they say: I do not see the text as a transparent window into social reality, or primarily as a formal structure; rather I see it as a work of language that organizes social agency” (4). The language is itself a means to understand the political goals of its authors. So, we began with a shared interest in women’s health and in interdisciplinary collaboration. Although these were shared sentiments, these are not immediately obvious why they warrant further research and scrutiny around OBOS. For DeCoster, his first memory of OBOS was in a health class in grade school. For Parker, she was unaware of OBOS until her years in college. However, for both of us as researchers, it became clear that this text was pivotal in changing how we understood both women’s health (as an academic field) and our own personal lives. As such, the ongoing impact and uptake from this text is undeniable. We took on the work that Kirsh and Royster ask of us—to “tack out”—that is, in order to find meaning from what is both written and unwritten, explicit and unspoken, requires us to

use critical imagination to look back from a distance (from the present to the past, from one cultural context toward another, from one sociopolitical location to another and so on) in order to broaden our own viewpoints in anticipation of what might become more visible from a longer or broader view, where the scene may not be in fine detail but in broader strokes and deep impressions.

(Kirsch et al.)

We as researchers worked to articulate meaning, but at different levels: for the patients we studied, for the original BWHBC authors, and for ourselves.

Archival Work on BWHBC

Taking into consideration the guidance from Royster and others to approach this work methodologically in a way that allowed, in as much as is possible, for the participants to speak and to tell of their own lived experience, our project had two major aims. First, we spent 2 weeks working in the Schlesinger Library (Cambridge, MA), which holds the archives of the BWHBC. This is where much of the materials are held, both of the writing of OBOS, but even the paperwork prior to this, notes from the BWHBC and more recent publications stemming from the original OBOS (Boston Women’s Health Book Collective “Boston Women’s Health Book Collective Records”). Although this group ultimately authored Our Bodies, Ourselves, this was not their original aim. As they write on the Our Bodies, Ourselves website:

We never planned to write a book. We believed then as we do now that there is no substitute for a small group of women—in a spirit of mutual trust and respect—speaking and listening to the truth of our own lived experiences.

(OBOS Founders)

Using the tools of rhetorical analysis, we were influenced by several concepts of Kirsch and Royster as well Royster’s questions in her earlier book investigating literacy and social change for African-American women. Critical imagination, which according to Kirsch and Royster, is the art of educated guessing in historical and archival work and exploring: “How do we transport ourselves back to the time and context in which they lived, knowing full well that it is not possible to see things from their vantage point? How do they frame (rather than we frame) the questions by which they navigated their own lives?…How do we make that was going on in their context relevant or illuminating for the contemporary context?” (Kirsch et al.). In our project, we are interested in how the women of the BWHBC came together, trusted one another and began working towards OBOS and what evidence we can find of alliance building and collaboration in the archives of their origin. In other words, we were curious about the process of the creative collaboration that resulted in OBOS in phase 1 of our project and then carrying those ideas forward to retaining uptake in a contemporary moment. The hope is that this understanding of the lasting rhetorical impacts on clinical interactions for both women and providers during pregnancy and birth can continue the collaborative potential of the BWHBC and OBOS.

The other concept that for us was significant is that of social circulation (Royster et al.). In Royster’s earlier work she asks about literacy and the ways in which literacy was a tool of empowerment for African-American women. For her, and for us, this leads to our questions of what strategies, if any, were in place in those early BWHBC meetings and interactions? How did the personal relationships of the women influence the texts and the women then and now as they are read fifteen or twenty years later? Using the idea of social circulation that allows us to bridge from the past, present, and future to understand the influence and longevity of OBOS and BWHBC while forcing us to begin with the women and their written texts.

This led us to the second phase of our research, where we sought to understand how OBOS and the BWHBC have influenced modern medical interactions around pregnancy and birth, We completed 11 interviews with women who had recently given birth to at least one child along with OB/GYNs and midwives to understand the experience of giving birth from both the women (n=6) and the clinician perspective (n=5) to think about the lasting influences of OBOS on modern clinical practice and to review the differences in clinical care between midwives/doulas and OB/GYNs to better understand the way the clinical staff interact with women during pregnancy and labor.1 For both the interviews with women and clinicians we followed a similar guide of questions we wanted to cover in our interviews. For women, we started with their birth experiences and listened to their stories, both good and bad, about their interactions with clinical providers. We also asked them about a few words or concepts, from our archival work, which we thought were important to understand from their perspective (e.g., autonomy, empowerment, and collaboration). In our conversations with clinicians, we asked a similar series of questions to elicit the reasons why they became the type of provider they are, where they work, and how they engage with patients. They were also asked to define, in their own words, the concepts that we talked to women about, e.g., collaboration or empowerment. The transcript and interviewer notes were used for analysis using a grounded theory approach (Strauss et al.) to create themes from the re-reading and review of the transcripts using the conceptual framework and outline from our archival project. The goal here is to allow for the women and clinicians to speak for themselves and their experiences and for us as researchers to utilize the actual words of the participants to describe the complexity of the situations and interactions that they experienced.

In “A Good Story” BWHBC members articulate their own struggles over power dynamics. The BWHBC chose a consensus model for decision-making and had a fluid-leadership model, similar to many other women’s health organizations (Morgen). As they grew they fought to maintain personal relationships and sharing, but some felt that this limited growth and efficiency because they were not always on the same page. “But adaptation had a price: paradoxically, the more the group developed medical knowledge and skill, the less access they had to vernacular bodily experience or to the lay experience of medical care” (Wells, 2008, p. 699). Wells helps to remind us that as BWHBC grew and came closer to the OBOS development, crafted subsequent revisions, and endured complexity around publishing over time, the women involved were more removed from their original location and the body.

In our archival work what we went in search of and ultimately found most interesting was the origin stories of the OBOS founders and their handwritten notes of the early planning meetings. These meetings were a simple group of women coming together typically in the evenings at someone’s home. The meetings were both formal and informal (Boston Women’s Health Book Collective “Minutes Notes September 1973-January 1975”) with collaborative goals as well as personal perspectives. The language was at times angry, resistant, personal, emotional, and ranged from a focus on “time to get ourselves together” to heated discussions over the pages allotted to each chapter. BWHBC was a group of friends and colleagues who had a desire to engage women and provide them with knowledge and information on their own, as well as to help empower them to advocate or engage with the medical system. In one particular set of meeting notes we found that after a discussion each individual was asked their own goals and the notes show a mini drawing of each woman from the note taker along with goals from each person that sometimes were connected to the larger book project (e.g., whether they were ready for revisions to the book) or were personal about “side” projects for further education, art projects, separate book proposals.

Fig. 1. Schlesinger Library. Boston Women’s Health Book Collective. Minutes Notes September 1973-January 1975.

Two archival examples are worth noting here, drawing from minutes of BWHBC. First, Norma [Swenson] is clearly moving across the private/public spectrum. She articulates her own professional development, “I’m going to school at Tufts.” But at the same time, she calls her colleagues together for further collaboration: “We need to spend much more time together. We’ve been apart a long time. The quality of relationship will be better.” There’s something important here: the importance of both individual and collective work is being articulated in this brief moment. Along with a reference to sharing food—quite literally—as she asks if others would like “some cold duck,” Swenson here is noting her desire for ongoing, engaged activity within the BWHBC group. Yet simultaneously, she articulates her own individual needs to grow, to expand her interests and her professional identity.

Esther [Rome], too, asks for more “personal discussions like we used to do.” There’s an important understanding here that individual and collaborative goals are deeply intermeshed: that for one to be successful, the group (BWHBC) must meet and also be successful. Esther, too, articulates her own side interest and projects, when she says she’s “still intrigued by [the] question of weight + fat…I want to do massage. That will take up a lot of time.”

In these meeting notes, we again see how themes of collaboration are reflected in the text.2 Planning meetings typically started with OBOS planning, then transitioned to individual discussion time for each of the attending BWHBC members. In the images, here, a cartoonish doodle of each speaker appears next to the text of each woman, describing her current interests and personal research themes. But even these individual reflections, Norma and Esther are referencing the “we” of the group and its work.

Beyond mere meeting minutes, these images and notes provide evidence of transition and transformation of individuals of BWHBC and the group itself. We see here that medicine can be studied, but that the women are collaborating in studying medicine and their own lives, interests, and values. And that the collaborative nature is better—“like we used to”, or “we need to spend more time together”—for such critical reflections. An outside critique of medicine is limited: working as a collaborative insider is more effective.

At a quick glance, the meeting minutes resemble little of what we might think of in more traditional academic circles of formal accounts of organizational meetings (Boston Women’s Health Book Collective “Minutes Notes September 1973-January 1975”). Engaging critical imagination, though, means we must be able to see the non-explicit work done in these meetings. For example, the note taker (unidentified) has crafted lovely doodles of her colleagues. These are brief sketches/doodles of the person herself and her colleagues, not just the recorded language of her arguments. While we describe them as doodles or cartoons, this is not to minimize them or their value. There is both formal and playful (or even loving) articulation of the work of the BWHBC recorded here. These moments describe the person and her goals—not just the health facts and themes—as relevant to the project at hand. Perhaps long-term this can help to explain the longevity and power of the BWHBC and OBOS because the personal was political. This work was not full of abstractions, it was individual and meaningful to each involved woman and this was translated to readers over decades that engendered support and engagement for themselves and with the clinical encounters (Wells 2008). For us, as researchers, this has meant thinking beyond the drawings and the simple “not knowing” of who the artist is in order to attempt to re-visit the time and space of that room and place. This helps us to theorize how politically important each word might have felt to the individual participants and how complex the compiling of information and collaboration together was for each of them.

Clearly, there was a lot more work being done at these meetings than “simply” the production of the OBOS pages. At this time, while the group was processing the project of reflecting on the first OBOS edition and considering the next revision, they were also reflecting on the nature of their group. Engaging critical imagination allows us to read deeper than what was recorded in the minimal meeting minutes. We see here that the members are bifurcated on how to proceed with their work, which projects to take up, and which to give priority to. There is the private work among the founders to determine who to trust and rely on within the group, and who to work with sitting on their couches with their young children nearby having a potluck dinner. There is the call for the development of both individual and collective expertise, but the articulation that these are intertwined in complicated ways.

Central to these minutes are how the members want to spend their collective and individual energies and time. We see repeated requests for the women of BWHBC to return to spending time together, both for social and individual goals, or writing (Esther: “We’re not ready to write a book for a year yet. We’ll need to do a lot of talking.”) and educational goals (Norma: “I’m going to school at TUFTS.”). It is here that their original models emphasizing collaboration and agency (individual and collective) are evident. These requests for talking—in face-to-face settings—is about individual health and well-being, the support generated between friends and respected colleagues. But critical imagination allows us to return to this work space, and describe what might have been a part of the conversation not contained in the minimal meeting notes. We see the BWHBC authors articulating the core values for their own collaborative system, and with a flexible sense of agency. In this way, we recover a richer meaning for these working meeting minutes. Although they are about developing the improved book product, they are also about refining the Collective and upholding its values.

At the same time as the public release of OBOS, teaching through the women and body course, and advocacy within the feminist women’s health centers led them to choose a path of negotiation within the medical establishment rather than completely working outside the medical system. What we did not find entirely within the archives were the answers to why these women trusted each other or engaged in this particular manner to arguably change the course of women’s health forever.

OBOS’s Legacy and Contemporary Connections with Birth

Building upon these archival concepts articulated from the BWHBC archives, and with our own remaining questions, through interviews we asked providers and women who had recently had at least one child how they identified who they could work within contemporary clinical practice. Specifically, we were interested in how practitioners and women understood the patient/provider relationship, when they thought it would work, how they knew it would not, and what they did to engage with each other. Perhaps unsurprisingly we found differences between how OB/GYNs and patients interacted compared to the interactions described by women and midwives.

Emmons’s process of uptake is useful here to understand how patient talk can result in medical directives. We utilize this concept to analyze the words needed for collaboration on both sides of the patient/provider relationship or how either a person or a provider can see his or herself as part of a collaboration. “Language manifests itself within the body via a series of intergeneric translations: A consultation interprets patient talk as a series of symptoms; a diagnosis responds to symptoms with a prescription; a pharmacist transforms a prescription into a medication; and a patient ingests the medication in accordance with the directives on the bottle, thereby incorporating in to the body a material response to an initial, purely rhetorical locution” (Emmons). Most notably we see differences in language used by midwives and doctors to talk to and with their patients and how that impacts the women they encounter. Looking back to the early days of the BWHBC and the “Women and Their Bodies: A Course” we see that language was used then as well to professionalize medical providers and another “…important way doctors set themselves off from other people is through their language. Pseudoscientific jargon is the immense wall which doctors have built around their feudal (private) property, i.e. around that body of information, experience, etc. which they consider as medical knowledge” (Candib).

Just as the women of BWHBC developed a complicated sense of shared expertise, so too did many of the women and clinicians we interviewed. In one way, it may seem perhaps jarring to talk about birth as a “collaborative process.” It is the pregnant woman who is giving birth, no matter who else is in the room. But as our interviews articulate, the work of finding collaborators—that is, women finding the right clinicians to support their delivery—parallels the individual/collaborative work of the women of BWHBC.

I really believe in empowering women and respecting their autonomy to make decisions about their health and their bodies and their birth…just seeing that, has driven me in supporting women as a doula, and then now, as a midwife, to be able to help educate women about [what] their options are, and help them make informed decisions, and then ultimately respecting the fact that they have the power to call the shots most of the time…

(Interview #27 p. 3; Midwife)

Well, I’ve always felt like—a couple of things—pregnancy was a normal state of good health. And clearly, as I gained more experience and more confidence, I think I also realized that this is the patient’s experience, not mine. My job was to assist the patient in her experience of pregnancy and childbirth. And this was not something where a pregnant mother would come in and could turn over her healthcare to me. So really from the get-go, it’s been more of a neutral, agreed upon relationship. I would encourage patients, for example, to write down their questions, stuff to ask me. I would be free to counsel patients and talk to them. Sometimes patients ask for things that I don’t think are medically indicated or medically correct, and we have a discussion about that.

(Interview #11 pp, 3-4; OBGYN)

Collaboration is more than just language and words. While these two approaches sound similar in rhetoric, the way the practices are enacted often results in highly different experiences for women. This leads again back to our archival work where we understand the process is sometimes as important as the outcome, especially for women.

So she [midwife] was much more confident and relaxed about pregnancy and birth in general. Until there is something wrong, everything is okay. Whereas I felt like with the obstetrician, he just had an attitude of expecting something to go wrong.

(Interview #13 p. 6; Mother)

Women indicate clearly that the experience with different providers can be unique. While it stemmed from language differences, it was much deeper and more powerful.  For example, the clinical providers we spoke to use the medical language of providers and patients, but the midwives talk about clients. One of the mothers we interviewed that had experiences with both midwives and OB/GYN practices explained this to us in the following way:

When a woman goes to a doctor, obviously, doctors—when they treat you—they refer to everybody, regardless of whether you’re pregnant or not, as patient. But I think that sets women up to not understand that their doctor works for them and that ultimately the medical choices are their choices not the doctor’s choices. So, I think that using the term client is beneficial to midwives and could be beneficial to the doctors if they wanted to use it to create that understanding that, as a human being, it’s your body. It’s your right to do whatever you want.

(Interview #14 p. 13; Mother)

We do not believe this is a subtle distinction, but that this rhetorical choice matters. It alludes to the power dynamics at play in the patient-provider relationship and the manner in which women and midwives have sought to disrupt that power dynamic. It also provides evidence for the uptake of the language of collaboration.

And there is a difference, I feel like there’s a difference between—a patient to me—a level of hierarchy? In—the way that client doesn’t necessarily, like it’s—I don’t know exactly what the distinction is, maybe you can—look that up in a dictionary or something but—it’s—it definitely feels like more of a partnership.

(Interview #1 p. 30; Midwife)

Think about that idea in its simplest form. What does a partnership entail between a woman and a clinical provider? How has that evolved over time? Do most women see their providers as partners? What role does the living text of OBOS have on such interactions? How did empowering women to understand their own body impact clinical encounters?

Our interviews illustrate that women with some providers, almost exclusively midwives, see a collaboration and a partnership that involves teamwork. Most women and clinical providers, however, do not emphasize or value this language and context. So much so that in the early work of these authors, one of us (Parker) thought the idea of collaborating with a provider for childbirth was beyond ludicrous. It seemed to undermine or minimize the work and importance of the woman in the birth process and to offer “credit” of some kind to providers, who can be disengaged bystanders to the process. If we take to heart the guidance of OBOS, the language of collaboration and equalizing power is critical. And, in fact, as noted above many of the women we spoke too and some of the providers demonstrate such language. While perhaps we have not accomplished this equalization for all women, it seems still an important and distinctive goal to seek.

Looking at the space and time surrounding the creation and evolution of the BWHBC and OBOS allows us to better understand the impact and consequences of the OBOS work in a more modern moment. In other words, looking beyond the book itself, to the values, perceptions, methods, and rhetoric of the book that matters for medical discourse, the engagement between patients and doctors, and, primarily, for providing patients with agency in health care interactions. Midwives are asking for a safe/healthy baby and a positive birth experience for women. Clinicians focus on a safe baby and mom in a similar way, but often worry less about the experience. For midwives, and arguably for women, the process matters, sometimes, as much as the outcomes.

In describing modern midwifery practice, midwives focus on relationships and the empowerment of patients rather than the language of OB/GYNs who speak about patient autonomy but reliance on clinical expertise.

…we believe that we’re not necessarily your care provider, you are your care provider. You’re the one, every day, making all kinds of decisions that influence you and your pregnancy, and your health and your baby’s health, and we’re checking in with you on that, and we’re acting as guides on that and we are—I think it’s educators who are giving lots of information or interpreting information that you’re getting from other sources. But you’re really the one that’s taking care of yourself, and we want to kind of put that in your lap, it’s yours. And that really takes the Western medicine view and kind of flips it on its head.

(Interview #1 p. 6; Midwife)

The patient doesn’t want to see the doctor, and no doctor that I know wants to see a patient who doesn’t want to see them. That’s just accepted. So we try to accommodate those [requests] as best we can. But there’s a big demand…I’m short. So that creates a problem in terms of availability and backlog. It’s not an answer, but it’s still all by the chart.

(Interview #11 p. 8; OBGYN)

The medical providers we spoke to, who appear to have the best intentions, still do not approach care in the same method or language as the midwife. For lack of a better description, the midwives and women talk about the women and child as a centralizing force and the clinician doesn’t really utilize the language of empowerment or talks about the support people or doulas as empowering rather than the women themselves. For example:

I think that pregnancy and birth are really a life-changing time for people, for better or for worse, and sometimes people’s personal histories. So I think that pregnancy and birth have the ability to be very empowering for people and help them kind of own their power. And so having a doula or a midwife or a doctor that respects that and recognizes that and is willing to advocate for you or help you to advocate for yourself can influence the way that pregnancy and birth are.

(Interview #27 p. 14; Nurse-Midwife)

Even if these are “aware” or supportive doctors, the physician often sees the doula as a tool of empowerment, rather than seeing a role to empower the woman directly. The argument from the women we spoke to is that without the “right” clinical support, they do not feel empowered, in control of their own bodies, or that birth is anything but a medical procedure. Here are just a few examples from our interviews of women indicating what lasting influences there were from their clinical interactions.

I’ve noticed that the midwives I’ve seen—most of them, regardless of whether they are a home-birth midwife or based at a center or regardless of differences, those that are midwives have kind of tended to take more time during each visit. They’ve kind of been more thorough in their explanations and listened well. I’ve had a couple of doctors—I don’t know—you know. Like I said, with my first daughter, he [OBGYN] listened and stuff, but the visits were short. Being a first-time mom, I didn’t really know what to ask, so I really didn’t ever have any questions. My second hospital visit for birth, I guess, was at a military hospital, so I don’t know if that implemented the abruptness of the visits. I’m sure it does. I know they’re very busy. You know. So they were just very different experiences, and they were both men and women. That could be a difference, too. The two hospitals—my first two, I saw men for my OB visits, and all of my midwives have been women. So, I don’t know if that contributes to the difference or not. That is very true. I think some of it is just a feeling you get. The doctors that I’ve seen—I’ve noticed how they tried to quickly explain something or just kind of, oh, trust me; whereas if I had a question, most of the midwives I’ve seen have taken the time to either pull out a picture or draw a picture or make sure that I was understanding the answer to my question in order to make the best decision for myself.

(Interview #14 p. 4; Mother)

Because I feel like the relationship that you develop with a caregiver might be compromised because of poor interactions…Sometimes they’re [OBGYN/clinicians] not set up to really give or establish a caregiving relationship. Often it feels a lot more clinical. It’s about checking boxes. And again, that’s like totally over-simplified.

(Interview #9 p. 2; Mother)

How does this notion of “checking boxes” feel to a patient? It seems unlikely that it is empowering to women or feels anything but an abstraction. Connecting this back to our archival work, we see the projects of the BWHBC as focusing on experiential knowledge of women; the idea that “women’s experiences, not clinical research produced by physicians, represented the most empowering, most liberating source of knowledge” (Kline).

Additionally, there are complex relationships and interactions between midwives, hospitals, providers, and patients that illustrate the levels of interactions and collaboration that must all work to facilitate a successful birth process for all involved.

Yes, for me that’s the easy part, the hardest part is the collaboration with the—the physicians because they don’t have this collaboration model as strongly as we do. And they don’t—I guess we worry, sometimes, that when we—that we are working with clients on one level and they’re working with clients on a level—on a different level and sometimes there’s not—we are free but they’re not going to get the same level of respect that we have for our clients.

(Interview #1 p. 33; Midwife)

Okay. I think that OB/GYNs are really, really good at dealing with high-risk pregnancy. That’s what they oftentimes should be doing. They’re good at surgery. They’re good at handling complications. They’re really great to have around to consult with if something unusual or more complicated arises. Midwives are excellent at taking care of women who are low risk, or maybe have higher risk things going on but are still able to be under the care of midwives. So for example, like women with gestational hypertension often can be cared for by midwives in consultation with a physician. I think midwives in births are really good at supporting women and sitting with them while they labor and offering emotional support, whereas doctors generally don’t do that. They tend to run in when the baby’s crowning and catch the baby and that’s it. So I think that midwives are good at helping to keep things normal when they are normal, and helping women who maybe have higher risk pregnancies still have the kind of birth experience that they want, to the extent that they’re able to preserve that, and offering emotional support.

(Interview #27 p. 7; Nurse-Midwife)

Tying this to the OBOS archival work, we find evidence in the contemporary world of the need from both clinical staff (OB/GYN and midwives) and women to navigate, articulate, and redefine their values individually and as a group as they work together on the “project” of a healthy birth/baby. Midwives seem to have addressed this, they have created more flexible ways of working with women, with physicians. Physicians are stuck in the self-critique model: do our way better, not create new ways of acting. Here, we again notice that uptake occurs between these systems of clinical care. Clinical decision making is something that was once made only by physicians. Yet we see the slow change, that patients can be active in their own decision-making. Decisions on how birth should occur is no longer the arcane or specialized domain of clinicians. Instead, it is shared experiences between clinical experts and the women that are impacted most.

Lastly reflecting on the work of the BWHBC and the founders of OBOS, we see lasting consequences today in the clinical relationship and how patients and providers engage and forge a relationship, in particular when they negotiate trust or when they determine it cannot work. Women and midwives talked about how they “just knew” or it just felt like their people when they interacted. In other words, there was a kind of social “chemistry” that allowed for some work to progress.doctors as “having taken a role of ‘honorary men’” (186), this does not prove particularly surprising. After all, patriarchal society has caused all women to objectify one another and be disgusted with their own bodies; female doctors naturally share in these prejudices.

Yeah, I think it’s like any relationship where you just—you know, you look at somebody and you’re just like, “Ah, you’re my people.” Sometimes the opposite happens where—we have amazingly too where we had a couple that was with us and I just cannot for the life of me figure out why they were with us. They just didn’t feel like our people.

(Interview #1 p. 32; Midwife; emphasis added)

I think that it depends on the level of trust, and that goes both ways. So you get a sense for if someone trusts you pretty quickly in the relationship. And then you have a feeling about the patient. If you—I don’t really know how to explain it very well. But there has to be trust in both directions.

(Interview #27 p. 9; Midwife)

Women describe two key features for collaboration and to forging relationships with providers. Listening is key.

I think a big part of it is whether the provider is listening—like listening to you and not just sort of brushing things off or addressing things in a very superficial way, but if you have concerns, I think that I want someone who I felt like is really listening to me. In the last practice, I have to say, they were five very different women. And for the most part, I met with most of them in various ways, because I had a non-stress test and things going on, a lot of providers. And I felt like that practice did a great job of actually listening to you. They may not always be able to solve what’s going on, but there wasn’t that sort of giant separation between you and the doctor, just sort of dismissing—dismissive attitude, that’s the word I’m looking for. So I think that I would look for a provider that I felt like was listening to me, probably someone that was—these days, that was a little bit—the reason that I would be more interested in a midwife is that I felt like—the second time was better. I went overdue the second time, but they were pressuring, somewhat, me to schedule an induction. And I ended up going into labor naturally. But I feel like for my third child, I want someone who is more flexible. I haven’t had—I’ve had easy pregnancies, easy, uncomplicated births, and I would like someone who listens a little bit more to what I want and is a little more flexible and less rigid about how things have to be, like you can only go so many days before I induce you, or—and so for those reasons, I think that a midwife would probably be a little bit better fit, if that makes sense.

(Interview # 17 p. 12; Mother)

And the other important factor is humanizing them as patients.

Just that they were—the two female[s] I felt like were personable. One was more reserved than the other, but both just treated me like a person…There wasn’t much you could do, but they were both reassuring about that. And just in general, pretty positive about the thing…the one male doctor, was very—fatherly, a little bit. Not really my style, but still fairly warm. And then the fourth doctor was just very chilly and very impersonal, and a little too familiar too, for someone I hadn’t met at all…“I’m getting close to the time, and how is this all going to go?” and was starting to ask legitimate questions for a first-time mom. And he’s like, “Yeah, I understand that you’re worried. People like you always—women always worry. But it’s going to be fine.” And I was like—first of all, I didn’t say I was worried. You don’t know me. So yeah, he just was not—yeah, and just a little too familiar, making too many assumptions about me without having actual…actual information. I felt like he didn’t humanize the experience very much, was sort of putting himself distant from—and I don’t think that’s a male-female thing. I don’t think a male doctor has to necessarily make himself distant from that, or a female doctor has to be closer to that experience. But I felt like he was just very, very distant from it, and turned me into more of a “her” as opposed to a—you know, he didn’t refer to me. Well, actually, I think he did refer to me once, talking to the nurse as “she.” “She needs to blah blah blah.” I’m lying right here with my legs up. You don’t need to—you can actually refer to me as a person.

(Interview #17 pp. 3 and 6; Mother)

Perhaps unsurprising it is easier to determine when a provider is a “no” rather than being able to define when a provider selection is positive and the variable characteristics. Again taking us back to the OBOS and BWHBC work, we went to the archives looking for evidence about why their collaborations work and why they were able to connect with each other to forge such an amazing change in women’s health care and did not find much of that evidence. Likely this is because those relationships faded or did not continue or were already in place prior to the 1970s timeframe of the BWHBC archives. We believe this is similar to the women who can’t articulate precisely when collaboration or a relationship exists with a provider, but are clear when it doesn’t work.

With the other doctor, I don’t even know. I don’t know if I’ve had a pleasant—I don’t think there was a pleasant interaction with him—you know—for the entire time I was there. Even after it was all over and he came to see me the next day…and I really wasn’t in that much pain, and he was like, “Oh, well, wait until that epidural wears off.” He was just not a nice guy. And then I saw him again for my six-week postpartum checkup. I don’t know why I made the appointment with him because I probably could have seen anybody. During that appointment—you know—it came up that I was like trying for a VBAC with my next pregnancy because I was already thinking that. After a c-section, I was like, “I’m not doing this again.” Right away he shot me down.

(Interview #13 p. 8; Mother)

I don’t think there’s anything that they could have done. I mean, we interviewed a couple midwives on paper, and in their philosophy, they were perfect for us. But we didn’t feel—it just didn’t feel right. We didn’t have that natural easiness with them that you do when you first meet some people and like we did when we met our midwife at the birth center. So, our general feeling, I’d say, was the deciding factor more than the facts on paper were.

(Interview #14 p. 11; Mother)

It is tougher. It is. And I think that one of the things that he didn’t do that other providers did do, one of the goods, is asking questions. Like how are you, what do you need, what fears do you have—those sorts of things. And it’s not even a level of concern about you as much as it is just like, I’m asking you questions because I want to know what’s inside your head. I’m opening up some sort of dialogue. It’s not that I’m worried about you or I need to be, or it’s not that we need to get emotional or personal, but I’m trying to have a conversation with you, because you’re going to have a baby, so let’s ask about you. And I think that, combined with reacting compassionately but calmly to all your rational fears—Is pretty key, goes a long way, and—I don’t know. It’s hard, because you can tell when a doctor sees you as a person and when a doctor just doesn’t want to interact on a personal level. […] Yeah, not just are you okay, but like, are you feeling depressed? Are you sleeping? Are you showering every day? Blah blah blah. That kind of stuff. Also, are you regaining bladder control?…at least a few leading questions to try and get into what’s going on in your head.

(Interview #17 p. 18; Mother)

There is an engaged dialogue, empowered dialogue. Notice how she continues to show the importance of asking questions, how questions set up the foundations of relationships. By asking questions, we engage the arcane knowledge of clinical medicine, but also create the foundations for clinical relationships. She is advocating for herself, but passively. And she sees signs of collaboration from the provider because he seems interested in her beyond her symptoms and into what she is thinking and feeling. 


In this project around women’s health, we have woven together two threads. First, we have begun with our own archival work in the BWHBC files. Here, we have found evidence for collaborations in the foundational writing of OBOS, that have thus far not been articulated.  In challenging ourselves to see historical records of this canonical text, we have articulated that collaboration, the choice of collaborators, and the issue of shared agency were methodological decisions embraced by the women of the BWHBC, who crafted OBOS. These methods allowed the founding women of OBOS to articulate both individual and shared research objectives. The women epitomized the idea that the personal was political and sought to share personal knowledge, empower friends/colleagues, and engage women in the medical establishment.

Similarly, we have traced the legacy of OBOS to contemporary birth experiences through our interview data to understand the uptake, if any, that exists for women and providers today in thinking about their collaborations together for the project of birth. Both women giving birth and their clinical staff collaborators have identified personal values that shape the experiences of a successful birth. Just as with the crafting of early drafts of OBOS, women today still navigate the complexities of individual and collective values through uptake or the origin of the BWHBC.


This work was done with support from the Albany College of Pharmacy and Health Sciences Scholarship of Discovery grant: “The Collaborative Self: Virtues for Seeking and Building Alliances in Health Care” (2016). We also would like to thank the reference librarians at the Schlesinger Library, Cambridge, MA.


  1. Using snowball sampling techniques, we approached a number women in our broad social network including that of our research assistants and emailed 10 women and 10 providers, roughly in an even split between OB/GYNs and midwives. The email contained a link to a REDCap intake survey hosted by the Albany College of Pharmacy and Health Sciences to ensure they were qualified for our study and to assess their availability for interviews. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies (Harris). Once potential participants completed the survey, they were called by a member of the research team to verify their interest in a telephone interview, consent the person into study participation, and schedule the interview. A trained interviewer, Parker, then called the participant at the appropriate time, verified consent for the interview, and asked permission to audiotape the interview. The interviews ranged in length from 30-60 minutes.
  2. To our knowledge, these small but powerful sketches have not been articulated or recorded elsewhere in the literature about the crafting of OBOS. Susan Wells, in her book Our Bodies, Ourselves and the Work of Writing, includes a similar doodle, “The Dragon of Our Joy” (p 30).  However, here, we are interested in how other meeting minutes reflected the work of the various OBOS authors.

Works Cited

Boston Women’s Health Book Collective. “Boston Women’s Health Book Collective Records.” https://www.radcliffe.harvard.edu/schlesinger-library/collection/boston-womens-health-book-collective-records.

—. “Minutes Notes September 1973-January 1975.”

Brubaker, Sarah Jane. “Denied, Embracing, and Resisting Medicalization.” Gender & Society, vol. 21, no. 4, 2007, pp. 528-552.

Candib, Lucy, editor. “Women, Medicine, and Capitalism, an Introductory Essay.” Boston Women’s Health Collective and New England Free Press, 1970.

Conrad, Peter. The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Johns Hopkins University Press, 2007.

Conrad, Peter and Allison Angell. “Homosexuality and Remedicalization.” Society, vol. 41, no. 5, 2004, pp. 32-39.

DeCoster, Barry. “Structural Concerns for Msm Health in Revising the Precautionary Principle.” The American Journal of Bioethics, vol. 17, no. 3, 2017, pp. 50-52.

Emmons, Kimberly K., editor. “Uptake and the Biomedical Subject.” Parlor Press, 2009.

Garry, Ann. “Medicine and Medicalization: A Response to Purdy.” Bioethics, vol. 15, no. 3, 2001, pp. 262-269, doi: https://doi.org/10.1111/1467-8519.00236.

Halfmann, Drew. “Recognizing Medicalization and Demedicalization: Discourses, Practices, and Identities.” Health, vol. 16, no. 2, 2012, pp. 186-207.

Kirsch, Gesa E. et al. “Feminist Rhetorical Practices: In Search of Excellence.” College Composition and Communication, vol. 61, no. 4, 2010, pp. 640-672.

Morgen, Sandra. Into Our Own Hands: The Women’s Health Movement in the United States, 1969-1990. Rutgers University Press, 2002.

OBOS Founders. “We Sparked a Women’s Health Movement by Speaking and Listening to the Truth.” https://www.ourbodiesourselves.org/2015/11/obos-founders-jumpstart-womens-health-movement/, 2019.

OBOS founders: Judy Norsigian, Vilunya Diskin, Paula Doress-Worters, Jane Pincus, Wendy Sanford, and Norma Swenson. “BWHBC and ‘Our Bodies, Ourselves’: A Brief History and Reflection.” https://www.ourbodiesourselves.org/issues-impact/articles-books-media-about-our-bodies-ourselves/bwhbc-and-our-bodies-ourselves-a-brief-history-and-reflection/. Accessed 28 April 2019.

Riessman, Catherine Kohler. “Women and Medicalization: A New Perspective.” Social Policy, vol. 14, no. 1, 1983, pp. 3-18.

Royster, Jacqueline Jones. Traces of a Stream: Literacy and Social Change among African American Women. University of Pittsburgh Press, 2000.

Royster, Jacqueline Jones et al. Feminist Rhetorical Practices: New Horizons for Rhetoric, Composition, and Literacy Studies. Southern Illinois University Press, 2012.

Strauss, A. et al. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Sage, 1998.

Wells, Susan. “Our Bodies, Ourselves: Reading the Written Body.” Signs, vol. 33, no. 3, 2008, pp. 697–723. JSTOR, www.jstor.org/stable/10.1086/52371.
—. Our Bodies, Ourselves and the Work of Writing. Stanford University Press, 2010.

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