The objective of this study was to identify factors significantly associated with the time to the first birth among women in Ethiopia.a cross-sectional study was conducted using data from the 2016 Ethiopian Demographic and Health Survey (EDHS). The study subjects were married women and men aged 15 to 49 in randomly selected households across Ethiopia and two stage stratified random sampling technique was used to select study subjects. Log logistic-Gamma shared frailty model was used to identify factors associated with the length of time spent until the first birth.the median age at first birth for women living in Ethiopia was 20 years, whereas the minimum and maximum ages at first birth were 11 and 49 years respectively. Age at first sex, age at first cohabitation, sex of household head, place of residence, religion, education level, contraceptive use and exposure to media were significant correlates of age at first birth of women in Ethiopia. Higher level of education was associated with increased age at first birth. Women who use contraceptive, women living in urban areas, women having exposure to media and female headed households had longer time to first birth compared to their counterparts.the different regions of Ethiopia have significant differences in the age of women during their first birth. Most of the factors associated with the time to first child in this study were related to education of women. Investing in education and educating women plays critical roles in regulating fertility of a nation and health of women. The first evident outcome of the fertility process is the birth of the first child. The first birth marks a woman´s transition into motherhood and signifies her on her future life and her roles and responsibilities. In the absence of any active fertility control, the age at which childbearing begins influences the total number of children a woman bears throughout her reproductive period, the cumulative effect being rapid population growth. There exists strong relationship between age at first birth and total fertility: the earlier a woman experiences her first birth, the more children she will have. For countries in sub-Saharan Africa, where contraceptive use is relatively low as compared with the developed world, younger age at first birth has strong effects on both individual and aggregate levels of fertility. Total fertility declines with increasing age at first birth -3. Age oSeveral factors such as parents´ socioeconomic status, education, wealth index, marital status, biological factors, region of birth, rural/urban origins and parents´ religion are assumed to affect the age of the woman giving birth for the first time were identified as significant determinants of the timing of the first birth ,10. LeveIt is expected that women who grew up in a rural setting will become mothers at a younger age than those who did not. Early motherhood may seem more attractive than pursuing a career when educational opportunities are limited, as they are in many rural areas ,14 EthioEven though the issue of mothers´ age at their first birth has wide-ranging consequences on total fertility and health of mothers, not enough research has been conducted to identify its determinant factors. In an attempt to identify factors influencing the timing of the first birth, use of appropriate statistical analysis method plays a considerable role. Several statistical methods have been used in studies aimed at identifying correlates of age at first birth ,13,16-19Data with a multilevel or hierarchical structure occur frequently in a wide range of research disciplines, including epidemiology, health services research, public health, education and sociology. When we have clustered data or subjects nested within some other hierarchy or repeated measures on a subject, individuals belonging to the same group are usually correlated and hence the assumption of independent observations in the modeling process does not hold. Multilevel survival models are used to model such types of survival data . In viewThe data: the dataset used in this study was obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS). The survey was conducted by the Central Statistics Agency (CSA) from January 18, 2016, to June 27, 2016, based on a nationally representative sample that provides estimates at the national and regional levels and for urban and rural areas. The survey target groups were women aged 15-59 in randomly selected households across Ethiopia.Study design: this study used a quantitative, cross-sectional design by analyzing data from the 2016 Ethiopia Demographic and Health Survey (EDHS).Ethiopia is constitutionally formed as a federation of nine ethnically-based regional states (regions) and two chartered cities. These eleven administrative regions have basic roles of managing public health services and coordinating the operation of health system under their jurisdiction. The 2016 EDHS sample was selected using two-stage cluster design. Census enumeration areas (EAs) were the sampling units for the first stage. The sample included 645 EAs . Households comprised the second stage of sampling. A complete listing of households was carried out in each of the selected EAs. A representative sample of 17,067 households was selected for the 2016 EDHS. Complete interviews were conducted for 15,683 eligible women of ages 15-49 years. This group of women having complete data comprised the sample for this study. To get unbiased estimates for population parameters in complex study settings like the 2016 EDHS sample which used a two-stage stratified cluster sampling technique, sampling weights based on sampling probabilities separately for each sampling stage and each cluster were used.The response variable in this study was the age of the mother at her first birth. It is measured as the length of time from her date of birth until the age at which she gives her first birth which is measured in years and is assumed to be continuous. If a woman did not give birth until the date of the data collection, the data is said to be right censored. If, however, a woman has given birth until the date of the data collection, we say the event (first birth) has occurred. This kind of data, where the duration of time until some kind of event occurs is of interest, is called survival data or time-to-event data. The independent variables that were known to be associated with the timing of first birth and considered in this study are sex of household head, wealth index, religion, education level, place of residence, contraceptive use, respondents´ working status, media exposure, alcohol consumption, number of siblings, age at first sexual encounter and age at first cohabitation. Survival data analysis is the appropriate method of dealing with time-to-event data. Parametric and non-parametric approaches of analyzing survival data were applied in this study. Descriptive statistics were produced for the different categories of women. The non-parametric methods (Kaplan Meier curves and the log rank test) were used to compare the ages at first birth of women in different categories of the factors. The Cox proportional hazards (PH) regression model is a broadly applicable and most widely used method of survival analysis. Important assumptions used in this model are that the observations from different subjects are statistically independent of each other and that the relative hazard (hazards ratio) does not change over time. This is known as the proportional hazards assumption.Researchers often encounter grouped or multilevel data like individuals nested within families, and families nested within neighborhoods. For instance, women aged 15-49 are nested within regions. Most multivariate models assume that observations are independent, while grouped data clearly violate this assumption. For example, as in this study, populations in adjacent areas are likely to display similar behavior, which can influence timing of first birth and causing it to be spatially auto-correlated. While it is commonly assumed that there is independence between the observations from different clusters, it will be unreasonable to assume that observations in a cluster are independent. Failure to take into account this clustering from such hierarchical populations typically leads to underestimation of standard errors. Multilevel survival analysis using mixed effects Cox regression model is used to model survival data when repeated measures are taken for each individual or the survival times are clustered (grouped) or individuals are nested within some other hierarchy, or some other reason to have both fixed and random effects . Parametj denotes the random effects associated with the jth cluster, ho (t) is the baseline hazard function, and Xi' =  is the vector of independent variables (factors). The term ‘shared frailty’ is used to denote the exponential of the random effect exp(αj). The random effect can be thought of as a random intercept that modifies the linear predictor, while the shared frailty term has a multiplicative effect on the baseline hazard function [where αfunction :in individuals in the thi group; Xij is the observable covariate vector for the jth individual in the thi group. Let ωi be the unobservable covariates for the thi group and ψ be the regression coefficient of the unknown covariates. The hazard function of the jth individual in the thi group is [Expanding proportional hazards model to include a random effect, called a frailty, allows for modeling the association between individual failure times within a group. A frailty acts multiplicatively on the hazard function and the model that incorporates this random effect into the hazard function is called the frailty model . Supposegroup is .Akaike´s information criterion (AIC) was used for model comparison. Data analysis were carried out using STATA, Version 12. All hypotheses testing to determine differences, associations and relationships were judged significant at p < 0.05.Ethical considerations: the ethical clearance for the survey was approved by the Ethical Review Board of Central Statistical Agency (CSA) of Ethiopia and all participants who agreed to take part in the survey and signed an informed consent form to participate in the study were included.Of all the 15683 women aged 15-49, 10274 (65.5%) had at least one child until the date of data collection. The median age at first birth was 20 years, while the minimum and maximum ages at first birth were 11 years and 49 years respectively. The median age at first birth is highest in the capital city Addis Ababa (27 years) and lowest in Amhara, Afar, Oromia, Benishangul, and Gambella regions (19 years each). The median ages at first birth for rural and urban women were respectively 19 years and 23 years. Median age at first birth increases continuously as the level of education of mothers increases; 28 years for women who have attained higher education and 19 years for women with no formal education. Muslim women tend to have lower median age at first birth (19 years) as compared with women following Orthodox Christianity in Ethiopia (21 years). The percentage of rural women who had at least one child until the end of the study period (73%) was higher than their counterparts in the urban (51%). Afar region has the highest percentage of women who had at least one child until the end of the study period (74.02) while Addis Ababa city had the least (41.67). Eighty-eight percent of women with no formal education had at least one child during the study period. The corresponding figures for women having secondary and higher education were 39% and 40% respectively .The Kaplan-Meier estimate of the survival curve is the best description of times to event of a group of subjects as it uses all the data currently available. The resulting KM survival curve based on EDHS 2016 dataset is shown in the following figures. Note that in this plot of survival time is being measured in years .Based on the nature of the data, several models were fitted and compared. A univariable analysis was performed for each potential model to see the effect of each explanatory variable on age at first birth and to select variables to be included in the multivariable analysis. To adjust for confounding, all factors which were independently associated with the time to the first birth in the univariable analysis were included in the multivariable analysis and comparison was done among the models using Akaike Information Criteria (AIC) value, where the model with minimum AIC value is considered a better fit for the data  Table 3Table 3. The variance of the random effect (θ) was significant for all multivariable parametric gamma shared frailty models implying that there is significant variation in the ages at first birth of women from different regions. It was highest when we assume the log logistic-gamma shared frailty model (θ=0.585). The Kendall´s tau (τ) was highest for the highest θ values. Accordingly, the dependency within the clusters for log logistic-gamma shared frailty model (τ=0.226) was the maximum. Based on the AIC criteria , the log-logistic gamma shared frailty model, having the AIC value of 2456.1928, was the preferred model for the dataset under consideration. Results of log logistic gamma shared frailty model showed that age at first sex, age at first cohabitation, sex of household head, place of residence, religion, education level, contraceptive use, alcohol consumption, and media exposure were the important correlates (factors) for the time to age at first birth . The valA variance of zero (?=0) would indicate that the frailty component does not contribute to the model, meaning that age at first birth does not vary among the different regions in Ethiopia. The likelihood ratio test for the hypothesis ?=0 presented at the bottom of Analysis based on log logistic-gamma shared frailty model showed that age at first sexual encounter, age at first cohabitation, sex of household head, type of place of residence , religion, highest education level, contraceptive use, alcohol consumption, and exposure to media were significant correlates of age at first birth at 5% level of significance. In contrast respondent´s working status, wealth index and numbers of siblings were not significant at 5% level of significance. Women, who have attended primary school, secondary school and higher education, had significantly different ages at first birth as compared to women with no education. An acceleration factor of greater than 1 indicates prolonging the time to age at first birth. Based on this criterion, women who attended primary school (Φ=1.0635), secondary school (Φ=1.1850), and higher education (Φ=1.3150) had prolonged age at first birth compared with women with no education. Women residing in rural areas of Ethiopia have entered into motherhood earlier than those residing in urban areas of the country (Φ=0.9492). Similarly, adolescents in female headed households have given birth earlier than those male headed households in Ethiopia (Φ=0.9986).Women using any contraceptive method had significantly different age at first birth than women who were not using contraceptives. The resulting acceleration factor showed that women who had used any contraceptive method had prolonged time at first birth by a factor of 1.0501 than women who have not used any contraceptive method. Regarding media exposure, women who had access to media had delayed time to a first birth than women who had no access to media (accelerating factor = 1.0395). Women who follow Catholicism had prolonged age at first birth as compared to women following Orthodox Christianity while Muslim women enter into motherhood earlier than women in the Orthodox group.The age at which the first child is born affects the total number of children a woman may have throughout her reproductive period and has many implications for different socioeconomic and demographic outcomes. Early motherhood, in addition to affecting the life of a mother in general, has significant contribution to the aggregate level of fertility and consequent population size at national level. This study applied log logistic-gamma shared frailty model to identify factors associated with the length of time spent until the first birth of Ethiopian women based on the 2016 Ethiopian Demographic and Health Survey (EDHS 2016) data set. A total of 15,683 women of ages 15-49 years having complete interviews were included in the study. The median age at first birth for women living in Ethiopia was 20 years, whereas the minimum and maximum ages at first birth were 11 and 49 years respectively.We found that place of residence was significant determinant of age at first birth in Ethiopian women; rural women had their first child earlier than urban women. This might be due to the fact that women in rural areas of Ethiopia are less likely to go to school and hence enter in to marriage earlier which results in bearing a child at early age. The institutional and normative structures such as the kinship and extended family and limited maternal health-seeking behavior of women in the rural areas also promote early childbearing. On the other hand, urban women need to pursue their career and gain more resources, and achieve maturity to manage an independent household prior to bearing a child and thus they have prolonged time-to-first birth. They also have a better access to maternal health and family planning programs as compared to rural women. The results are in line with studies ,16,29,30Women´s level of education affects their knowledge and usage of modern contraceptive methods, and delays entry into marriage, which reduces the exposure time to risk of childbearing. This is also linked to women´s working status. The educational level of women had a significant effect on time to first birth and it prolonged age at first birth by a factor of Φ=1.0635, Φ=1.1850 and Φ=1.3150 for primary, secondary and higher education respectively compared to illiterate women meaning that women who have attained higher education are more likely to have delayed entry to motherhood compared with those with lower level of education or no education at all. A study on adolescent first births in three East African countries; Uganda, Kenya and Tanzania also revealed that adolescent first births, particularly at the youngest ages, are most common among the poorest and least educated . A numbeet al. [We found in this study that Catholic women had prolonged age at first birth compared with followers of the Ethiopian Orthodox church while women who follow Muslim, Protestant and other religions had shorter age at first birth. This finding was consistent with a study in Uganda by Mugarura et al. . As expeet al. ,36,37, uet al. ,36,38,39Watching television (TV) and listening to radio at least once a week were considered to measure exposure to media for both women and their partners in the 2016 EDHS. In this study, we found that exposure to media had a significant effect on age at first birth in that women who have access to different media stayed longer to give first birth than women who had no access to media. This is logical as many family planning and maternal and child health awareness creation programs are communicated through mass media. These results are in line with other studies .Study limitations: some important variables related to male partners were not available which may have effects on the model parameters. In the complementary log-log binomial linear model with mixed effects a large value of AIC was obtained. One important reason may be due to the fact that the dataset was restructured, and the follow-up time (age at first birth) was discretized into interval for as the model requires. Such discretization process may result in a loss of information and may fall short of explaining the hazard of age at first birth by the effect of covariates.This study was aimed at identifying correlates of age at first birth among Ethiopian women using survival analysis methods on the 2016 EDHS. It was found that the median age at first birth for the whole nation was 20 years. Women from Addis Ababa city have the largest age at first birth (27 years). The findings from this study showed that there was a clustering (frailty) effect on time to age at first birth among women living in the different regions of Ethiopia implying that women living in the same region share similar risk factors related to birth. Women residing in urban parts of Ethiopia, women having better education and women who were using any contraceptive method had prolonged age at first birth as compared to their men counterparts. Access to media also helps to prolong age at first birth. As level of education increases, the median age at first birth also increases. It should be noted in general that women´s level of education affects their knowledge and usage of modern contraceptive methods, their working status and their ages of entry into marriage, which influence their exposure time to risk of childbearing. Therefore, educating women plays a critical role in regulating the time to the first birth.Multivariate models assuming independence of observations across all regions were used to model similar data; this assumption leads to underestimation of standard errors;Age at first birth is low in Ethiopia as compared to the global average.Regional states have significant variations in age at first birth;Since women in the same region resemble more than women in other regions clustering among regions was considered and multilevel survival analysis using mixed effects Cox regression model (shared frailty model) was used to model the given data;Most of the factors associated with the time to the birth of the first child in this study were related to education of women.


In adults, vallecular cysts are usually asymptomatic but can present with respiratory and gastrointestinal manifestations. A 45-year-old man presented with a four-month progressive history of dysphonia, dysphagia to solid, snoring, choking, apnea, and aspiration. On examination, the patient was vitally stable with no remarkable local and physical examination. Flexible nasoendoscopy, computer tomography, and subsequent micro-laryngoscopy revealed a non-pulsating, non-congested 3 x 2 cm cyst obscuring vocal cord visualization. The cyst was removed completely by cold and hot techniques and was sent for biopsy. This case report presents the successful management of a symptomatic vallecular cyst through electrocautery. A vallecular cyst is a rare anomaly in pediatrics and adults. It has different names, such as mucous retention cyst, pre-epiglottis cyst, epiglottis cyst, base-of-tongue cyst, and ductal cyst. Most cases in the current literature are presented as case reports that detail adult intubation challenges or occlusion of the newborn airway . VallecuA 45-year-old soldier was referred from Mohail General Hospital with a history of progressive changing of his voice as well as dysphagia for solids for four months. Shortening of breath, aspiration, and frequent choking during sleep progressively developed over the next three months. Furthermore, he had witnessed apnea, daytime fatigue, and snoring. He was a smoker with a history of gastroesophageal reflux disease. There was no history of recent weight loss, night sweating, loss of appetite, fever, infection, surgery, hospitalization, previous same presentation, allergy, and no medical or family history. On examination, the patient was vitally stable with a pulse rate of 82 beats/minute, respiratory rate of 18 cycles/minute, systolic blood pressure of 132 mmHg, diastolic blood pressure of 79 mmHg, and oxygen saturation of 94% on room air. Intact cranial nerves and no lymphadenopathy were noted. The local and systemic examinations were unremarkable. Computed tomography on the head and neck revealed a well-defined 3 × 2 cm hypo-dense, cystic lesion on the vallecular, filling the airway with no other laryngeal abnormalities (Figure Flexible nasoendoscoy revealed a non-pulsating, non-congested cystic mass originating from the vallecula, measuring 3 × 2 cm without any discharge. His airway was compromised, his vocal cords could not be seen, and signs of gastroesophageal reflux disease were detected (Figure The patient was admitted for micro-laryngoscopy. Intubation was done by a bogie and 7.5 rigid laryngoscope tube. The vallecular mass was completely resected by cold and hot techniques and was sent for histopathological examination. Histopathological examination revealed a cystic lesion lined by stratified squamous epithelium with no malignancy observed Figure .Postoperative follow-up for one month revealed significant improvement without recurrence or aero-digestive symptoms.Ductal and saccular cysts are types of laryngeal cysts. When the collecting ducts of the submucosal glands become obstructed and retain mucus, ductal cysts occur. Inflammation, irritation, or trauma may lead to the blocking of the duct . MeanwhiIn adulthood, vallecular cysts are more frequent but less hazardous. The majority of cysts affect men in the fifth decade of life . The symFiberoptic laryngoscopy can identify masses in the vallecula but cannot differentiate between a vallecular cyst, thyroglossal duct inner cyst, dermoid cyst, thyroid lingual tissue, lymphangioma, hemangioma, or teratoma . ComputeIntubation is usually a challenge. Fiberoptic intubation without a relaxant has been considered effective. However, it was difficult in some cases with a displaced larynx and large vallecular cyst. In some instances, rigid laryngoscopy and intubation can be effective. In neonates and infants, careful decompression of the cyst after local anesthesia could be successful but aspiration of a mucoid cyst is difficult. In most cases when all methods of intubation fail, tracheostomy is done . In this2 laser excision, can be used. Cyst aspiration is not advised as a final treatment because of the high likelihood of recurrence [2 laser. These techniques allow excellent depth perception, perfect surgical precision, and good control of postoperative edema and pain besides being suitable for all age groups [For treating vallecular cysts, surgical procedures, including cyst aspiration, marsupialization, surgical debulking, and electrocautery or COcurrence ,15. It ie groups -18. In te groups . When thA vallecular cyst is an uncommon lesion. Although it is usually asymptomatic, physicians should suspect the presence of a vallecular cyst when adult patients suffer from combined respiratory and gastrointestinal manifestations. Resection with the use of electrocautery is an effective management technique.


This essay is about why and how we should introduce birth into the canon of subjects explored by philosophy. Birth care brings to the fore fascinating philosophical questions: is a woman in labour a subject with full rights in practice as well as in theory? Can a labouring woman exercise her autonomy in a situation of maximum vulnerability but also maximum lucidity and awareness, as characterises the work of giving birth? What is the relationship between agency, capacity, and pain during and between contractions? Birth care proposes key questions relating to knowledge, freedom, and what it means to be a human being. Nonetheless, giving birth continues to be a blind spot in contemporary prevailing philosophy.logos forgenos —a radically new meditation on origin and birth. My approach to a philosophy of birth aligns with one of the aims of contemporary philosophy; I explore the relationship between knowledge and emancipatory action in the relatively unchartered waters of birth and delivery, to create an epistemology that is sensitive to feminism and embodiment. What I propose to achieve through a philosophy of birth is a newsituated knowledge challenge widely-held assumptions about rationality, about what it is to be a birthing woman and what it is to have agency and capacity in the delivery suite. A philosophy of birth enables us to navigate the stormy waters of contemporary obstetric practice towards a new and radical logos for genos —an embodiedgenealogy which not only redresses imbalances of gender, but also addresses life and happiness. How we understand our origin and the practices that bring us into being reveals our humanity. The lived experiences of women and their  Every human life begins with gestation and birth. However, in the thought and culture with which I am most familiar —commonly known as Western philosophy— delivery and birth have received considerably less attention than death and mortality. Feminist philosophers and thinkers have criticised this imbalance, rescuing delivery and birth from a state of omission or abandonment. The philosophy of birth constitutes a vibrant and growing field of contemporary critical thought, to which I add my own voice, principally in analysing how much of birth care continues to underestimate the capacity of a woman in labour to behave rationally. Women frequently have their rights breached during childbirth, and we need to know why this happens before we can fix it effectively. This essay takes an innovative approach to explaining how we can protect women´s rights during childbirth.Every human life begins with gestation and birth. However, in the thought and culture with which I am most familiar —commonly known as Western philosophy—, delivery and birth have received considerably less attention than death and mortality., Arendt, Schelling, Freud, or, most recently, Sloterdijk, the outcome is the same: we are talking of a deafening silence —a silencing even.Birth is addressed by philosophy both in real terms and as a metaphor in various arguments. Nevertheless, although philosophers have considered questions related to birth, in particular the ethical and metaphysical aspects of the creation of human life, they have paid scant attention to the actual processes of delivery and birth. Even considering the work of Plato.In contrast, mortality has taken central stage in the history of philosophy. There are many thinkers who identify philosophy with learning to die, but relatively few consider birth a subject for philosophy and even fewer give delivery or pregnancy a second thought. In this respect, the Heideggerian expression that characterises human existence —albeit excessively— as ‘being-toward-death’, captures the imbalance that pervades the history of philosophy as we generally know and teach it, Adriana Cavarero, Luisa Muraro, Sara Ruddick, Grace Jantzen, Iris Marion Young or Christine Battersby, from years ago. Or, more recently, of Christina Schües, Alison Stone, Elselijn Kingma, Sara Cohen Shabot, Sarah LaChance Adams, Jonna Bornemark, Andrea O´Reilly, Luce Irigaray, Fanny Söderbäck, Andrea Nye, Johana Oksala, Jane Lymer, Sara Heinämäa, Lisa Baraitser or María Martín, among others.Feminist philosophers and thinkers have criticised this imbalance, rescuing delivery and birth from a state of omission or abandonment. Their reflections make up a body of varied and opposing thought. I am thinking of Virginia HeldThe philosophy of birth constitutes a vibrant and growing field of contemporary critical thought, to which I add my own voice.Pregnancy, labour, and birth are unique human experiences, not comparable to others. They involve the creation of a new person by means of a profoundly intimate process that transforms the mind and body of the woman, whether during gestation or in labour, along with her frame of understanding and evaluation of herself and her environment.The processes of pregnancy, labour, and birth give rise to central philosophical questions in epistemology, metaphysics, political philosophy, and ethics. The field of birth is fertile ground for exploring questions and answers provoked by themes relating to the body, citizenship, health, or technology.Birth care brings to the fore fascinating philosophical questions: is a woman in labour a subject with full rights in practice as well as in theory? Can a labouring woman exercise her autonomy in a situation of maximum vulnerability but also maximum lucidity and awareness, as characterises the work of giving birth? What is the relationship between agency, capacity and pain during and between contractions? Birth care as a professional field for healthcare personnel and the healthcare system proposes key questions relating to knowledge, freedom, and what it means to be a human being. Nonetheless, giving birth continues to be a blind spot in contemporary prevailing philosophy.The philosophy of birth can be approached from the perspective of the philosophy of medicine, or from the relatively recent field of the medical humanities. In adopting these perspectives, I see obstetrics as an empirical and symbolic space where contemporary thought reformulates the meanings and metaphors of gestation, labour, delivery and birth. Moreover, a philosophy of birth has additional value when it is based on empirical data and medical practice, and therefore my questions, arguments and philosophical conclusions have as both their starting point and their goal, the current debates within obstetrics. Naturally, approaching birth from a philosophical point of view will reveal new horizons of thought, however, I know from experience that this can also have a real impact on clinical practice. Recently, when she was given a professional award an obstetric colleague expressed her gratitude for what she had learnt from philosophical conversations and mentioned how they had influenced her clinical practice.. But sometimes we retell events differently to the way in which they happened. In my case, I began using the expression ‘philosophy of birth’ to describe not what I was reading, but what I was thinking; what I wanted and what I needed to think and communicate based on my experiences. It is still important to me to hold on to the memory that identified the genesis of this expression in my life and in my philosophical endeavour.Giving birth can be better understood against the backdrop of a complex web of emotions inevitably produced by the relationship between knowledge, power and practice that characterise every situation. I use these formulations to emphasise that the questions which arise when a woman falls pregnant are questions that affect subjects who are subjects in every sense —political, moral, epistemic, sexual or legal—, and who need to be considered from this point forward, as much from a philosophical as from an obstetric perspective.On the strength of my varied experiences, I became interested in reflecting on what I call ‘the pregnancy of the subject’ or ‘the pregnant subject’I am told that my assertion is radical, but I maintain that our conception of the world and of humans is reflected in the notion of pregnancy, labour, and birth. I am convinced that the rules which govern our view of the world and of human life are compromised by the myriad rules that govern the processes of pregnancy and birth —from medical training to the management of hospitals, from statutory budgets to employment law.logos,arkhé,Ur-— with ‘birth’,our birth.Philosophical reflections on the question of origin have a long history of identifying ‘origin’ with key concepts such as ‘beginning‘, ‘logos’, or ‘foundation’, as developed by the great exponents of the history of philosophy. But what happens when we take the expression ‘rethink the origin’ literally? In philosophy we are not used to associating ‘origin’ —logos or study ofgenos, in which the Greek termlogos refers to the word in the sense of meditated, reflected, or reasoned, and the termgenos refers to the Indo-European root ‘gen-’, which means ‘give birth to’ —as in ‘genesis’ or ‘generate’.Rethinking origin means exploring genealogy. I understand ‘genealogy’ in its literal sense, as a.My intention is no less than to rethink the concept of origin itself. What I propose to achieve through a philosophy of birth is a new ‘logos’ for ‘genos’ —a radically new meditation on origin and birth.To explore the construction of an alternative genealogy I target obstetrics, one of the paradigmatic places where society constructs discourse around our origin. A philosophical analysis of texts and medical protocols from modernity to the present time reveals the conceptual skeleton of this type of genealogy. What are the hidden assumptions underlying obstetrics and many current practices in pregnancy and birth care? I intend on exposing these assumptions to the light of what philosophers’ call ‘emancipatory conscience’My approach to the philosophy of birth as genealogy has three distinctive characteristics. Firstly, I differ from many colleagues in this field in that I pay special attention to the moment and the experience of giving birth, rather than to the fact of being born. If you like, I focus on who is giving birth rather than who is being born.Secondly, in charting the perspective of feminist philosophy to explore these questions in depth, I trace my own nautical map which —like other forms of representation— speaks of a specific context, time, and navigation. Other mappings are possible of course; the waters of the philosophy of birth are open to everyone to sail them as best they can.logos forgenos. Understanding how obstetric practice constitutes and expands on contemporary discourse around the construct of origin enables me to formulate a narrative of critical importance around childbirth and birth care practices in health facilities across the world.Thirdly, my research focuses on a peculiar genealogy —obstetrics; literally a, Dutilh, Kail, Owen, Haslanger, and Koopman; or to the analysis of genealogies as conception of genos by Queloz, Pettit, Kitcher, Fricker, Williams, and Craig. However, while a meta-genealogy is often conceived as a genealogy of the philosophy of genealogy —in other words a genealogy of the views on genealogy by Nietzsche, the Sophists, or any other proponent of the philosophy of genealogy canon—my meta-genealogy is conceived as a genealogy of thescience of origin or rather of obstetrics, as a field of medical science that influences contemporary thought and ways of life in significant ways.Understanding the origin of our discourse on origin is in itself a meta-genealogy. My pursuit of this meta-genealogy aims to identify obstetrics as the science of origin that defines what it is to be human for today. My work on genealogy and meta-genealogy adds to recent philosophical research in the field, in particular to discussions of the genealogy of genealogy by Srinivasan, and I agree with her claim that philosophical feminism needs to define a genealogy devoid of patriarchal influence. Personally, I am interested in studying how obstetrics and obstetric practice continues to be significant, as both the source and development of contemporary discourse on the nature of origin. Therefore, I explore a potentially controversial hypothesis: that the very survival of patriarchy itself is closely linked to a certain understanding of and approach to care during pregnancy, labour, and birth. Consequently, I want to extract the philosophical value —both social and political— of the medicalisation of pregnancy, birth, and the post-partum period. If we consider the hypothesis that obstetrics is one of the pillars on which patriarchy solidly rests, then any rational criticism of patriarchy will unavoidably imply a rational criticism both of obstetrics and the assumptions that underpin its daily practice. Analysing the excessive medicalisation of birth is therefore a mandatory step in a contemporary criticism of patriarchal reasoning.The Spanish philosopher Celia Amorós studies genealogy in the history of philosophygenos shows to what extent obstetrics all too frequently continues to fulfil the function of legitimising the use and abuse of women's bodies, and the mistreatment or violence that many women receive at a critical point in their lives. To understand this, we should be aware of studies and reports by national and international organisations that denounce the tremendously damaging effects of certain unjustified and unjustifiable —but commonplace— practices carried out on women giving birth.From the point of view of gender, a glance at contemporary science concerned with establishes obstetric violence as a violation of human rights. Obstetric violence, for which we now have data, statistics, and even laws, is one manifestation of gender violence which characterises patriarchy.Violence against women giving birth has become so normalised that it is still not considered as violence against women —almost as if its habitual nature renders the violence invisible. The term ‘obstetric violence’ has been coined to refer to the violence suffered by women in health centres during birth care, and the recent 2019 UN Special Rapporteur's Report on Violence against Women in Reproductive Health Settingsall around the world and affects women ofany socio-economic status. Published data confirms that women who are victims of obstetric violence are often silenced or are too frightened to speak out because of taboo, stigma, or the belief that the violence they suffered might just be an isolated incident. However, their testimonies demonstrate that mistreatment and violence during birth are both widespread in practice and deep-rooted in healthcare systems.Stories of trauma told by women in testimonies received by the Rapporteur demonstrate how mistreatment and violence against women giving birth in health centres happensObstetric violence often adopts the form of medical procedures such as episiotomies or caesareans in cases where there is no physiological justification. The practice of carrying out extensive gynaecological examinations during maternity care can cause damage to pregnant women and their babies, and the excessive use of synthetic oxytocin to induce contractions and labour also causes damage to health. Women reported that some health facilities failed to respect their privacy and confidentiality when carrying out vaginal examinations, even performing them in front of third parties. Many women in different parts of the world have described profoundly humiliating practices and verbal aggression that take place behind closed doors in health settings. It is only recently that women have started to talk about the mocking and reproaches, the insults and shouting they have had to put up with from health personnel. Sexist and offensive remarks have been particularly noteworthy. Testimonies of women have described comments such as: ‘You didn't cry when you did it; open your legs or your baby will die, and it will be your fault’ (UN Report 2019: 12).Women also reported a lack of respect for their autonomy and for their capacity to make decisions, including their choice of birthing position. The UN report tackles the question of informed consent as a human right and as a safeguard against this type of violence. However, frequently women are denied the right to make informed decisions about the care they receive during birth, an omission which constitutes a violation of human rights that their respective states and health systems are responsible and accountable for.In a nutshell, the report emphasises that all such practices must be identified and treated as violations of women’s human rights.. For the first time, a UN legal organisation recognised the existence of obstetric violence and demanded that a state adopt measures to combat it. The ruling confirms obstetric violence as a serious breach of human rights and as an act of discrimination. The discrimination is premised on the fact that since only women can give birth, when women are not granted access to high quality gynaecological and obstetric services they are placed in a position of inferiority and inequality compared to men. The ruling is also ground-breaking in terms of the measures it outlines: it recommends that the Spanish state educates judges and health professionals about obstetric violence and that ‘remedies’ or solutions are put in place so that women should not suffer obstetric violence in Spain. The ruling also recommends that if women do suffer violence, they must be afforded compensation and reparation.As an example of the widespread nature of these practices, in 2020 the United Nations convicted Spain of human rights violations in birth care in an historic ruling which serves as a precedent for the rest of the worldgenos, we reveal serious questions about power, autonomy, and vulnerability. If maternity services are to become safer, person-centred, and values-based, we need to view the ethical and legal aspects of women’s birth experiences through the lens of feminism, socio-legal theory, and philosophy. The extent to which women have agency during facility-based childbirth is a critical challenge in our access to full citizenship.In summary, if we examine the contemporary science concerned with. As women, we and our children survive detrimental treatment of our bodies and attacks against our decision-making capacity and our freedom of choice, through practices which —most importantly— are carried out without any clinical justification.A philosophy of birth helps to explain why these reports of human rights violations, far from reflecting sporadic incidents or episodes experienced by women during their lives, ‘are part of a continuum of gender-based violence that occurs within a wider context of structural inequality, discrimination, and patriarchy, and is the result of a deficiency of education and training at various levels’ (Villarmea and Kelly 2020: 519).Exposing the absurdity of patriarchy in its purest and most basic form as it affects our entry into the world and impacts on those who introduce us to the world is philosophical territory. Philosophy, which Plato called the ‘medicine of the soul’, can use its scalpel to reveal those theories and practices which today still oppress and denigrate women's bodies. I refer to the naturalisation which maintains that biology imposes more restrictions on women's rationality than on men’s, an idea derived from the traditional view of rationality as a human characteristic that is radically distinct from our biological features, let alone from the features that govern reproduction and birth. According to this traditional view, there is, allegedly, an unbridgeable chasm between the spheres of birth and reason.My work in the philosophical field of birth considers human birth through the lens of the history of the naturalisation of women’s rationalitythink but think less clearly than men because they are more directly affected by irrational biological processes that impair their capacity as rational agents. The more intense and painful these processes are, the more they impair women’s rational capacity. If the mere presence of a uterus were enough to disturb a woman's reason, it is obvious what will happen when the uterus is working at full capacity during labour, with all the pain that accompanies it. A woman in labour fits the paradigm of irrationality perfectly.In essence, the naturalisation of women’s rationality consists in maintaining that women, and why, despite being enshrined in law, the rational and legal capacity of a woman giving birth is not always upheld in practice.Reconstructing the history of the naturalisation of female rationality is therefore key to evaluating current birth care practices and to identifying the assumptions underlying the reality that in delivery units informed consent is more implied than guaranteed.I will briefly outline an example of the naturalisation of reason in obstetrics; the Enlightenment debate about the ‘thinking uterus’. In the 18th century, medicine, now based on new science and empiricism, was fascinated by the relationship between women's brains and their uteri, and doctors were concerned with understanding how these two organs were connected. An ‘analysis of the “thinking uterus” debate illuminates the different ways in which various arguments were used to justify the subordination of women; sometimes emphasizing the connection between the uterus and thought and sometimes negating it, but always concluding that women’s inferiority is to be found in some known or yet-to-be-discovered anatomical and, primarily sexual, deficiency or problem’ (Villarmea 2021: 22).An unexpected actor intervened in the debate: the famous adventurer Giacomo Casanova, who mocked those arguing over ‘lana caprina’ or nonsense. Casanova maintained that the difference between the reasoning of men and women lies not in their organic make-up, but in their social and educational background. Until now, his staunch defence of the cognitive capabilities of women has received scant attention in specialised studies on the fight for sex and gender equality. My investigation helps to reveal this little-known contribution from Casanova. Concluding that women are inferior by emphasising the connection between a woman’s uterus and her cognition is an historic argument. The age-old interpretation of the uterus as an organ which transforms women into wild beings, both irrational and uncontrollable, may continue to permeate modern-day obstetrics despite contemporary medicine and science being supposedly free of such prejudices. I believe that a philosophy of birth can be immensely valuable in diagnosing fallacious assumptions and implicit biases about the relationship between the womb and reason, and in challenging potentially toxic narratives that have a major impact on birth care.Beyond noting certain prescient moments in the fields of medicine and the history of ideas, I aim to delve deeper into a number of age-old stereotypes that persist in contemporary obstetricsEven in countries with high standards of living, high quality birth care is inconsistent and frequently falls short in respecting the rights of those it serves. My focus re-evaluates the frontiers of autonomy and legal capacity in the delivery room, using the instruments afforded us by the epistemology of medicine. Through analysing obstetric debates, I describe and prescribe the agency of pregnant women and women in labour using the principles of critical epistemology. Pregnant women and women in labour, a singular and vulnerable group with a basic human right to dignity, also deserve to benefit from the analytical tools of emancipatory philosophy.I am formulating a philosophy of birth that views birth as an act which is intrinsically governed not only by nature and physiology, but also by cultural interpretations and personal significance. My research tackles the social, legal, and individual context of birth in order to test our notions of agency, autonomy, capacity, rationality, embodiment, and gender. I bring the history of ideas, medical epistemology, and feminist philosophy into close dialogue with our best empirical understanding of life sciences, especially human reproductive physiology, obstetrics, and midwifery. This range of subjects, which I gather under the rubric ‘philosophy of birth’, addresses what I believe is a critical philosophical task., and we continue to be affected by the practical consequences of these historical narratives. The footprint of these narratives goes far beyond simple disputes within a specific discipline —we still experience the very real impact of these gender stereotypes in childbirth and therefore we must address them.It is well-known that throughout history philosophers have underestimated women's capacity for rationality. They developed ideals and conceptions of reason which were either not designed with women in mind or which directly excluded them. This politically problematic history has both reflected and contributed to systems of injusticeThese stereotypes can be observed very clearly in our field of study —the mental capacity of a woman in labour. A woman in labour far from embodies the typical or ideal characteristics of a rational agent. But rationality, which relates to reason, is more than comparing stock market values to decide where to invest your money.rational since, in order to find an appropriate birthing position, she has evaluated the resources and options available to her. Everyday philosophy calls this practical reasoning or practical use of reason, which involves life experience. I am reminded that nature documentaries view chimpanzees piling up boxes to reach bananas as proof of a cognitive learning process, while the decisions a woman takes to find a good birthing position are not recognised as a cognitive process. How is it that chimpanzees show a spark of intelligence by climbing on boxes, but a woman moving around during labour is simply ‘following her animal instincts’?The woman in labour who decides she wants to get up and move around is indeedprudent, in the Aristotelian sense— than we think. Ultimately, perhaps her cry ispremeditated. After all, a woman in labour is not a being from another world; she is keenly aware that our culture interprets the heart-rending cry of a labouring woman as a paradigm for total loss of control. You only need watch the films. Consequently, in this context, many women think very carefully before releasing loud cries —not to mention they may prefer not to be a nuisance, another typical learned reaction which demonstrates a certain medical socialisation. For these reasons it takes courage to emit the first cry, to try it out, see what happens and if it seems good to continue —‘good’ of course, in relation to what is actually being attempted, i.e. giving birth. But it may simply be that a woman in labourknows her cry will help her, because she haslearned that guttural sounds emitted from one’s throat open the birth canal. There is a direct connection between the muscles of the throat and those of the pelvis —opera singers learn that controlling their pelvic floor helps them reach some of the highest or lowest notes. If this is the case, we will need to start admitting —as hard as it may be— that women may learn, in ante-natal classes or in conversations with friends, that crying out may help them. When the moment arrives, they try it out and it helps. And that is why they continue. They choose, test, evaluate, and confirm —pure method. Why are we so reluctant to acknowledge what they do isrational?Another example in the case of a woman in labour relates to her cry. A labouring woman’s cry is considered non-rational behaviour; a sign that she has lost control. However, it may be that a woman crying out during labour is being more rational —more. A cry uttered during labour need not be any different. The cry is a sign of something. The patriarchal context interprets it as a lack of control, but the interpretative context may be different: we may interpret the guttural sound as a way of maintaining the rhythm of breathing and working through the pain. Among humans, a cry or guttural sound can have many interpretations; it can be an order, a limit, a lament, a vindication, relief, an impact, a mantra, or an expression of pleasure, to mention a few. Why should it not also be anintentional action that opens up an organ to facilitate entry to a unique existential space?Ludwig Wittgenstein explained that the meaning of a sign cannot be innately interpreted; rather, a sign needs the context of social practices to realise its meaning. There are also contexts in which ‘significant others present at childbirth push with the laboring woman, adding themselves to her pushing, supporting her in her efforts without even reflecting on this’ (Cohen Shabot 2020: 10). Interestingly, ‘when people are made aware of the fact that they are pushing with the woman in labor, they generally stop pushing, at least for a time’ (La Chance Adams and Burcher 2014: 76). Reflecting on the phenomena of ‘communal pushing’ or empathetic sharing of cries during labour would introduce yet another rich perspective in our discourse.Of course, there are contexts in which the cry means something else, which is why it is so important to remember that the cry is a sign. It can, for example, signify that the birthing woman is expressing her fear or anxiety, her complaint, or protest. Or it might be the way she asks for an epidural. There are even contexts in which the person crying out —the person learning to cry out— is the husband or partner, in a striking and emotional projection of empathy or solidarity: ‘In certain tribes of the Amazon, women still customarily give birth on a river bank. While the woman is labouring, her partner lies in a hammock and cries out, mimicking the pains of child birth. This ritual is intended to trick evil spirits into focusing their attention on the man, thus protecting the woman and child from harm’ (Quintero 2001: 12)et al. 2020: 6). Research shows that ‘women may feel they are worlds apart from people in the same room, that the universe has narrowed to this one task they have to do. Some women mention transcendental experiences; of feeling part of the divine, the universe or gaining a deeper understanding of, or being a part of, nature’ . In those contexts, screaming during labour does not mean being ‘out of herself’, but being simply ‘in herself’.There are other explanations too. Further on during labour, a cry might cease being rational behaviour in the sense of being premeditated to connect a means to an end, or as a learnt resource. With luck, at a certain point during labour, behaviour which started for cultural reasons enters a distinct and interesting phase that I will refer to for simplicity's sake as physiological. Once a woman has tested the virtues of her cry; once she is confident of its value and has used it to transition to the next stage of labour, her scream might become something else, for example a tool for navigation or a —loud— mantra for concentration. Then her cry signals that everything is going well; she feels safe to land on 'planet birth' —a notion that refers to women's descriptions of being or entering into another time zone, space, or even world during labour. ‘As the labour intensified, women withdrew into an inner world where time seemed to be suspended. Women described how this inner space allowed them to concentrate on the labouring process, and this facilitated the feeling that they could manage’  sphere of interest. It also means she is equipped with the epistemic resources to best interpret her needs, claims, fears, and hopes.A situated epistemology of birth is therefore material for feminist thought. In my view, being pregnant and giving birth are fertile. Epistemic injustice refers to those forms of unfair treatment that relate to issues of knowledge, understanding, and participation in communicative practices. According to Fricker, there are two kinds of epistemic injustice: testimonial injustice and hermeneutical injustice. Testimonial injustice relates to assigning less credibility to the words of some population groups. Hermeneutical injustice is disadvantaging people by misinterpreting their social experiences. Epistemic injustice involves a variety of behaviours and practices, including exclusion and silencing; invisibility and inaudibility; systematic distortion or misrepresentation of people’s meanings or contributions; undervaluing of people’s status or standing in communicative practices;andmarginalisation as the result of dysfunctional dynamics, amongst others.In recent years, Miranda Fricker´s notion of ‘epistemic injustice’ has received considerable philosophical attention.Women who have suffered obstetric violence also suffer these types of injustice. A situated epistemology of birth will hone the analytical tools to unveil and redress wrongful treatment and unjust structures in meaning-making and knowledge-producing birthing practices                                                                                ‘unnecaesarean’                                                     An unnecessary caesarean, especially one coerced without evidence-based medical grounds.                                                                                E.g: Her doctor convinced her to have an unnecaesarean.                                                                                By Unnecaesarean, 17 January 2009                                                                                And the woman said. And the woman said: ‘It was not a necessary caesarean —It was an unnecaesarean.’ And the word made sense. And the woman saw that it was good. And the cogs engaged. Humans do not cope well with a lack of explanation, with absurdity or with nonsense; seeking an explanation  is a constituent aspect of human nature. The woman said: ‘unnecaesarean’ and in so doing ‘fermented’ not only the explanation but the action itself as I will explain.. We describe when we say how things are; we prescribe when we say how things should be; we produce when on making a statement we carry out the action expressed in the statement. This can be more easily understood with the help of familiar examples. If I say: ‘I promise to pay you back the money’, in that moment I am carrying out a promise. The promise did not exist until I made it a reality by expressing it with words. I not only say that I promise but my promise is made a reality, which does not mean that I will fulfil it, only that it exists as a promise from now on. When we register a daughter at the registry office and provide her name, we not only communicate to the official the name that we have chosen for our daughter, but in the act of pronouncing her name when registering her, weproduce her name socially, i.e. wename her. From now on, it will be her name. As these examples show, when we speak we are often doing more than just pronouncing words, we are constructing the furniture  of the world. That is why John Searle calls this type of linguistic act ‘institutional fact’.When we talk, we do a number of things. As J. L. Austin argues in his theory of acts of speech, language does not only describe, but also prescribes and even producesSimilarly, when I declare: ‘This is an unnecaesarean’, I describe not only a fact —an unnecessary caesarean— but I condemn it and offer it up for public condemnation. To call a surgical intervention ‘unnecaesarean’ is to do three things at the same time: (1) to classify it epistemologically as falling outside evidence-based medical best practice; (2) to condemn it morally and politically as illegitimate; and (3) to show it to be proof of respect owed and not received, condemning it legally.The way that words are used to clarify their meaning is important. When we say: ‘This was an unnecaesarean’, we attest to the fact and we commit ourselves to explain why we said it. Robert Brandon said that assertive acts —those acts in which we either affirm or negate something— ultimately denote commitment. In affirming that it was an unnecaesarean, I agree to participate in the rational practice of asking why, how, when, where, for whom, by whom, and for what purpose this caesarean is or is not, was or was not, necessary.In this sense, an essential function of the philosophy of birth is to legitimise  certain novel linguistic uses of the three closely interrelated aspects I mentioned earlier: epistemic, ethical, and legal. I will now focus on the philosophical legitimisation of these linguistic practices.Imagining, discovering, using, and promoting the use of a term. Imagining, discovering, using, and promoting the use of a term is something the speakers of a language do. The idea that it is possible to coin new terms —in this case ‘unnecaesarean’— may give the false impression that anyone can introduce new vocabulary into circulation simply at whim. But language does not work like that. Changes we propose cannot be arbitrary inventions by individuals; they must be based on a rigorous analysis of the way of life and culture of speakers of a language, and proposals must be shoe-horned into existing rules governing expressions.The reasons for reforming language are practical and pragmatic as well as theoretical. Reform requires political, social, educational, and economic decisions, to name but a few. The success or failure of a women’s human rights project depends on our capacity to clarify the concrete meanings of a good number of relevant terms, based on the way of life of the women involved. Accordingly, specifying that in a particular situation the thing that was called ‘caesarean’ was ‘unnecaesarean’, consists of an unsurpassed linguistic efficiency, which is to say an optimal epistemic, moral, and legal efficiency. A single term thus expeditiously articulates, evaluates, and gives guidance as to the right or wrong of a significant number of events.. Recent data shows that as many as 27.2% of births in the most developed global regions occur by caesarean section. We must therefore be concerned that potentially two-thirds of all caesareans carried out in developed regions are not justified on medical grounds. Furthermore, a glance at the data for when most caesareans are carried out reveals that the highest number of interventions take place just before Christmas, Easter, summer, and public holidays. Given this data, it is reasonable to suggest that the epidemic of caesareans discussed by national and international bodies is in fact, an epidemic of unnecaesareans.The World Health Organisation (WHO) states that the ideal rate for caesarean sections is between 10–15% of all birthsdeclare them has extraordinary semantic, pragmatic, and epistemic value. It is true that the semantic value (that which relates to the meaning or sense of the expression) of ‘unnecaesarean’ is identical to the expression ‘unnecessary caesarean’, but the expression ‘unnecaesarean’ has the advantage of communicating the content in a manner at once concise, clear, and to the point. Furthermore, its pragmatic value (the way in which context influences the interpretation of meaning) lies in offering us the following choice: either claim the expression simply denotes bad practice or understand that it points to a level of intervention and control of women's bodies which can only be interpreted as practice that goes beyond mere medical negligence. Finally, the expression also has epistemic value since it discloses both the frequency of hospital malpractice and it highlights when further examples of this practice occur. At this point we might like to pause to consider that if two-thirds of urological operations on male patients were unjustified on medical grounds, would we take it lying down?The fact there are so many unnecaesareans as to make the term necessary confronts us with a certain pattern of behaviour within medical practice surrounding delivery and birth. We should be asking for whom and for what purpose does this behaviour exist? Therefore, to talk of unnecaesareans, to name them as such and toAny language is related to a specific way of life. Any language is related to a specific way of life or way of thinking or behaving that is peculiar to a specific community. We cannot change language without at the same time changing the world in which it is embedded. This is the fundamental lesson we learn from emancipatory movements..It will be some time before we see the expression unnecaesarean included in dictionaries and in common use —possibly as much time as is needed to change the world in which we give birth, and in which our voices are heardIn the meantime, activism around birth will continue to use and promote the expression. Yes, that was an unnecaesarean.On Certainty to analyse the conceptual innovation produced by birth rights activism. My thesis is that emancipatory movements do not construct languageex novo; rather, they proceed from the understanding of how a particular segment of language works, they eliminate any confusion surrounding certain terms, and they propose a creative usage which illuminates meaning. This form of intervention certainly gives rise to mental and linguistic good health, but, above all, it contributes to political and moral health.As I said at the start of my essay, my focus on the philosophy of birth enquires into the relationship between knowledge and emancipatory action. In my work on normativity and practice in the emancipatory use of language, I apply Wittgenstein’s method from.I welcome Richard Rorty´s interpretation of Wittgenstein which is both hotly debated and also inspiring. Rorty emphasises the function of words as catalysts of change: imaginative uses of language are fundamental to starting to talk in a different way or to imagine a better version of ourselves, as Rorty would say can be built.This line of investigation reveals how an emancipatory use of language functions within organisations defending the application of human rights to gestation, birth, and post-partum. In accepting the shared social responsibility that should characterise the evaluation of health care, these birth rights organisations create a space where medical protocol can be debated, where health systems can be reformed and improved, and where a deliberative democracyBirthing women are autonomous beings and have the right for their autonomy to be protected. To acknowledge the autonomy of mothers is to confirm women’s right to life, health, bodily integrity, and freedom from discrimination, in other words to respect their dignity, equal status, and human rights.Montgomery v Lanarkshire Health Board. The Montgomery ruling led the way in establishing that women have the right to make decisions regarding their care during childbirth.Montgomery makes it clear that informed consent is a fundamental principle of health care: anyone receiving medical treatment must agree to undergo that treatment. Particularly significant are Lady Hale’s words: ‘[g]one are the days when it was thought that, on becoming pregnant, a woman lost, not only her capacity, but also her right to act as a genuinely autonomous human being’. Words are catalysts of change.Montgomery has normalised the pregnant subject as a fully entitled subject.The importance of autonomy, informed consent, and good communication in maternal healthcare decision-making has been confirmed by a landmark court ruling in the United Kingdom, the 2015 Supreme Court decision on. We are working on it.The philosophy of birth reminds me of an inspirational phrase: if you want to change the world, try to change the conversation. In addition, I believe that our very conception of the world and of humankind is reflected in the way we labour and birth.The anthropologist Sheila Kitzinger once said: ‘In any society, the way a woman gives birth and the kind of care given to her and the baby points as sharply as an arrowhead to the key values of the culture’ (Kitzinger 1978: 141)Declaration of the Rights of Woman and of the Citizen in 1791, de Gouges mirrors the language of the famous 1789Declaration of the Rights of Man and of the Citizen and explains that women, just as men, are guaranteed natural, inalienable, sacred rights, and that political institutions are responsible for protecting these natural rights. She writes:Reading Olympe de Gouges never fails to inspire me. In the preamble to her.‘Mothers, daughters, sisters, representatives of the Nation, all demand to be constituted into a national assembly. Given that ignorance, disregard or the disdain of the rights of woman are the only causes of public misfortune and the corruption of governments [they] have decided to make known in a solemn declaration the natural, inalienable and sacred rights of woman; this declaration, constantly in the thoughts of all members of society, will ceaselessly remind them of their rights and responsibilities, allowing the political acts of women, and those of men, to be compared in all respects to the aims of political institutions, which will become increasingly respected, so that the demands of female citizens, henceforth based on simple and incontestable principles, will always seek to maintain the constitution, good morals and the happiness of all’In publishing her document, de Gouges hoped to expose the failure of the French Revolution to recognise gender equality. However, she was unable to make any lasting impact on the direction of the Revolution. As a result of her writings, de Gouges was accused, tried, and convicted of treason, which resulted in her immediate execution. She was one of only three women beheaded during the Reign of Terror —and the only woman executed for her political writings.Declaration of the Rights of Woman of 1791 is significant because it focuses attention on a set of feminist concerns or aims, which have yet to be achieved. In 1989, two centuries after the French Revolution, the philosopher Virginia Held could still claim: ‘Only when the conscious experience of mothers, potential mothers, and mothering persons are taken fully into account can we possibly develop understanding that may someday merit the descriptionhuman’ (Held 1989: 388).Thesituated knowledge challenge widely-held assumptions about rationality, about what it is to be a ‘birthing woman’ and what it is to have agency and capacity in the delivery suite. A philosophy of birth enables us to navigate the stormy waters of contemporary obstetric practice towards a new and radicallogos forgenos —an embodiedgenealogy which not only redresses imbalances of gender, but also addresses life and happiness.How we understand our origin and the practices that bring us into being reveals our humanity. The lived experiences of women and theirThe literature on the damaging effects of certain unjustified and unjustifiable practices carried out on women giving birth is vast and varied. I have chosen the following studies to illustrate the range of analysis:J Eval Clin Pract: 1–8.Begley K, Daly D, Panda S, Begley C. (2019) Shared Decision Making in Maternity Care: Acknowledging and Overcoming Epistemic Defeaters.et al. (2018) Interventions to Reduce Unnecessary Caesarean Sections in Healthy Women and Babies.The Lancet 392.10155: 1358–68.Betrán, Ana Pilar, Marleen Temmerman, Carol Kingdon, Abdu Mohiddin,et al. (2019) Value based maternal and newborn care requires alignment of adequate resources with high value activities.BMC Pregnancy Childbirth 19.428: 428.De Jonge A, Downe S, Page L,The Lancet Maternal Health Series. URL:http://www.maternalhealthseries.org/explore-the-series/too-much-too-soon/ (accessed: 8 December 2020).London School of Hygiene and Tropical Medicine (2020)Maternity Services in England 2013-14 (2014) London: House of Commons Committee of Public Accounts. URL:https://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/maternityservices-report/ (accessed 11 November 2019).Morse A.,National Maternity Review. Better Births. Improving Maternity Outcomes in England. London: NHS England. URL:https://www.england.nhs.uk/wp-content/uploads/2016/02/nationalmaternity-review-report.pdf (accessed 11 November 2019).NHS England (2016)Universal Personalised Care. Implementing the Comprehensive Model. London, England: NHS. URL:https://www.england.nhs.uk/wpcontent/uploads/2019/01/universal-personalised-care.pdf (accessed 11 November 2019).NHS England (2019)BMC Pregnancy Childbirth 14.223: 1–11.Nieuwenhuize MJ, I Korstjens, A de Jonge, R de Vries, A Lagro-Janssen (2014) On Speaking Terms: a Delphi Study on Shared Decisionmaking in Maternity Care.Council of Europe Resolution 2306 (2019). URL:http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-EN.asp?fileid=28236&lang=en (accessed 8 December 2020).Parliamentary Assembly (2019) Obstetrical and gynaecological violence,Papeles de Trabajo del Instituto de Estudios Fiscales, Serie economía 8: 1–38.Recio, A., and J. M. Arranz (2020) Evaluación del Impacto de la Estrategia de Atención al Parto Normal sobre las Tasas de Cesáreas y Mortalidad Perinatal en España [An Impact Evaluation of the Strategy for Normal Birth Care on Cesarean Sections Rates and Perinatal Mortality in Spain].BMJ 348: g2192.Sokol, D (2014) Let's Stop Consenting Patients.Obstetrics and Gynaecology Workforce Report 2017. London: The Royal College of Obstetricians and Gynaecologists.The Royal College of Obstetricians and Gynaecologists (2017)World Health Organisation (2018) WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience. Geneva: WHO.Again, literature on obstetric violence is vast so I offer here a selection of references to reflect the breadth of approaches:et al. (2005) ‘I Felt as Though I’d Been in Jail’: Women’s Experiences of Maternity Care during Labour, Delivery and the Immediate Postpartum.Feminism & Psychology 15(3): 315–342.Baker, SRNursing Research, 53.4: 216–224.Beck, Cheryl Tatano (2004) Post-Traumatic Stress Disorder Due to Childbirth: The Aftermath.Dilemata 18: 93–111.Bellón, Silvia (2015) La Violencia Obstétrica desde los Aportes de la Crítica Feminista y la Biopolítica.et al. (2015) The Mistreatment of Women during Childbirth in Health Facilities Globally: a Mixed-Methods Systematic Review.PloS Medicine, 12.6: e1001847.Bohren, MeghanComing to Life: Philosophies of Pregnancy, Childbirth and Mothering, ed. Sarah LaChance Adams and Caroline Lundquist, 215–240. New York: Fordham University Press.Charles, Sonya (2013) Disempowered Women? The Midwifery Model and Medical Intervention. InThe European Journal of Women´s Studies 24.2: 128–142; (2020b) Why ‘Normal’ Feels So Bad: Violence and Vaginal Examinations during Labour – A (Feminist) Phenomenology.Feminist Theory, DOI:https//doi.org/10.1177/1464700120920764; Cohen Shabot, Sara and K Korem (2018) Domesticating Bodies Through Shame: Understanding the Role of Shame in Obstetric Violence.Hypatia 33.3: 384–401; and Cohen Shabot, Sara (2016) Making Loud bodies ‘Feminine’: A Feminist-Phenomenological Analysis of Obstetric Violence.Human Studies 39.2: 231–247.Cohen Shabot, Sara (2020a) We Birth with Others: Towards a Beauvoirian Understanding of Obstetric Violence.et al. (2010) Women’s Perceptions and Experiences of a Traumatic Birth: a Metaethnography.Journal of Advanced Nursing, 66.10: 21422153.Elmir, RakimeDilemata 18: 113–128.Fernández Guillén, Francisca (2015) ¿Qué es la Violencia Obstétrica?Women’s Birthing Bodies and the Law: Unauthorised Medical Examinations, Power and Vulnerability, ed. Camilla Pickles and Jonathan Herring, 155–170. Oxford: Hart.Murray, Claire (2020) Troubling Consent: Pain and Pressure in Labour and Childbirth. InWomen’s Birthing Bodies and the Law: Unauthorised Medical Examinations, Power and Vulnerability, ed. Camilla Pickles and Jonathan Herring, 127–142. Oxford: Hart; and (2019) Leaving Women Behind: The Application of Evidence-based Guidelines, Law, and Obstetric Violence by Omission. InChildbirth, Vulnerability and Law: Exploring Issues of Violence and Control, ed. Jonathan Herring and Camilla Pickles, 140–160. New York: Routledge.Pickles, Camilla (2020) When ‘Battery’ is not Enough. InDilemata 18: 13–26.Recio, Adela (2015) La Atención al Parto en España: Cifras para Reflexionar sobre un Problema [Birth Care in Spain: Figures for Reflection].et al. (2016) Moving beyond Disrespect and Abuse: Addressing the Structural Dimensions of Obstetric Violence.Reproductive Health Matters, 24.47: 47–55.Sadler, MichelleJournal of Psychosomatic Obstetrics and Gynecology, 29.4: 268–273.Thomson, Gill and Soo Downe (2008) Widening the Trauma Discourse: The Link between Childbirth and Experiences of Abuse.Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice. Geneva: World Health Organization.WHO (2006)No data are associated with this article. This is a sincere, engaged and thoughtful discussion of a topic which has been under-researched for a long time and is now luckily receiving more attention. The author provides a very helpful, comprehensive bibliography which can also be useful for future research in this area. The argument is persuasive and well structured. It is particularly unusual and impressive to see resources from analytic philosophy utilised for an investigation of childbirth."I am told that my assertion is radical, but I maintain that our conception of the world and of humans is reflected in the notion of pregnancy, labour, and birth.” – To my mind, these should be two sentences, and I would like to hear more clearly which assertion is radical.“Thirdly, my research focuses on a peculiar genealogy —obstetrics; literally a logos for genos.” This makes it sound as if obstetrics literally meant ‘logos for genos’, which is obviously not the case. It would be good to reformulate. The etymology of obstetrics is also interesting, by the way.https://doi.org/10.1177/174046810400100202).When it comes to the idea and concept of genealogy, I recommend Alison Stone’s article “Essentialism and Anti-Essentialism in Feminist Philosophy” . In sum, I think this is a useful and well-argued paper. My early comments are only meant to be as precise as possible in pointing out areas for clarification. Overall, I believe the author's argument is efficacious and adds to the on-going literature.Is the argument persuasive and supported by appropriate evidence?YesIs the work clearly and cogently presented?PartlyIs the topic of the essay discussed accurately in the context of the current literature?YesDoes the essay contribute to the cultural, historical, social understanding of the field?YesReviewer Expertise:bioethics , ethics, social and political philosophyI confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Response to Stella Villarmea’s “A Philosophy of Birth: If you want to change the world change the conversation” “A Radically New Meditation for Philosophy” Sarah LaChance Adams University of North Florida As Stella Villarmea notes, philosophy has often taken death as its existential foundation. This is due in no small part to the exclusion of women from the practice of philosophy.[1] It would indeed be a radical shift to reorient its conversation toward birth, specifically toward the origin of life in the female body.[2] Villarmea rightfully “pay[s] special attention to the moment and experience of giving birth, rather than to the fact of being born. If you like, [she] focus[es] on who is giving birth rather than who is being born.”[3] Even classical psychoanalysts, who many of us include among the philosophers, consider the mother-child relationship only from the perspective of the (adult) child, and for the purpose of understanding the mother’s role in causing psychopathology.[4] In bold contrast to this history, Villarmea insists that the birthing woman is not only the author of her own experience, but also a philosophical authority.Malleus Maleficarum (1486), said that midwives were the worst of the witches. Progressively, midwifery was overtaken by obstetrics, described as “the gradual attempt by man to extricate the processes of birth from women and call it his own.”[7] Francis Bacon’s decree to rule over disorderly nature with masculine force was underway. “What has been especially brought to light is what now appears as a virtual obsession with the untamed natural power of female generativity, and a dedication to bringing it under control.”[8] Given this history, to take the birthing woman’s guttural cry as rational and authoritative poses a radical challenge to the foundations of scientific inquiry. Some philosophers will dispute that Villarmea’s focus on birth can fundamentally challenge epistemology or even obstetrics. Perhaps they will grant that it may bring new knowledge, but only data that can be added to what they already know. This would be to misunderstand the origins of these disciplines. While this is not the place for a detailed account, it has been thoroughly argued elsewhere that the presumption of women’s irrationality is intertwined with the origin of obstetrics.[5] For instance, scholars have demonstrated that many women accused of witchcraft were, in fact, midwives. Since their principles and methods were not understood via religious or scientific methods, they were deemed magical or supernatural. The scientific method was likened to a witch trial and “the secrets of nature [were] imagined as deliberately and slyly ‘concealed’ from the scientist.”[6] Kramer and Sprenger, authors of the notoriousMeditations (1637). Descartes worries: What if I am hallucinating? What if I am dreaming? What if god is really an evil demon? His misgivings about the shaky ground for his knowledge were justified, but not for the reasons he thought. Modern philosophy’s first principles were to pursue knowledge as an isolated individual, ignoring the social and political situation, and all relations of power and economics. In truth, no one can, or does, do this. In contrast, feminist epistemologists have demonstrated how fundamentally our context impacts our “objectivity” and the further practices that follow from them. For example, Alcoff argues that we should examine our pretenses to neutrality and observe the “fact that scientific knowledge emerges from social praxis that occurs in the interface between scientific and political/economic institutions, and that the latter have determinate effects not only on the principles of research but on the hypotheses that are considered plausible.”[9] Sound knowledge requires an inclusive dialogue that is cognizant of the power dynamics that may be influencing its conclusions. Doubt and anxiety have been part of philosophy’s epistemological disposition at least since Descartes’The Meaning of Life. A woman is going into labor among several male obstetricians who are more interested in “the machine that goes ping” than in the woman herself. When she asks them “what do I do?” One doctors replies, “nothing dear, you’re not qualified.” The conversation that Villarmea calls for—medical humanities—advances this critical inquiry, which is badly needed to combat the notion of pregnant bodies as passive containers for fetuses. Consider Emily Martin’s devastating and humorous critique of gender biased accounts of human reproduction. They describe sperm as heroes that carry out a “perilous journey” into the “warm darkness,” where some fall away “exhausted.” “Survivors” “assault” the egg and the successful candidates surround the prize. The egg is “a dormant bride awaiting her mate’s magic kiss, which instills the spirit that brings her to life.”[10] I am reminded of a joke in the Monty Python’s movieought to be superfluous; but it is a very practical question indeed.[12] Scholars provide ample evidence that medical interventions are undertaken against women’s consent and knowledge. For instance, Villarmea estimates that as many as two-thirds of caesarean sections are not medically necessary, a claim that is bolstered by the observation that the highest number take place before holidays and summer vacation.[13] Although the World Health Organization and the United Nations have begun to acknowledge the existence of obstetric violence as a human rights issue, it remains largely invisible. Villarmea highlights how the presumed passivity and irrationality of women leads to widespread obstetric violence—a variety of invasive, humiliating, and terrifying medical procedures.[11] Villarmea’s question “Is a woman in labour a subject with full rights in practice as well as in theory?”logos forgenos.[14] Clearly, where human rights are violated, there is a dire problem. They dictate our formal obligations to each other and assert our fundamental equality and dignity as human beings. Nevertheless, I think, and I believe that Villarmea would agree, birthing women deserve further consideration. The ethical and political tradition that provides theoretical foundations for human rights are based on a notion of human beings that “sprung out of the earth, suddenly, like mushrooms, come to full maturity, without all kinds of engagement with each other.” . They are not born and are never dependent on anyone else. This tradition lacks Villarmea’sethos that is more consistent with Villarmea’s genealogy. Benhabib claims that human rights consider us asgeneralized others, a way to equality that can overshadow important distinctions; while she advocates that we treat one another asconcrete others. Seyla Benhabib offers an alternate paradigm to the prevailing Western tradition, an The standpoint of the concrete other…requires us to view each any every rational being as an individual with a concrete history, identity, and affective-emotional constitution. Our relation to the other is governed by norms of equity and complementary reciprocity: each is entitled to expect and to assume from the other forms of behavior through which the other feels recognized and confirmed as a concrete individual being with specific needs, talents, and capacities…The moral categories that accompany such interactions are those of responsibility, bonding, and sharing.[15]ethos to Villarmea’s genealogy. The perspective of the concrete other recognizes individuality, perspective-sharing, cultural diversity, and relational-subjectivity. It is at work in friendship, solidarity, and caring. Benhabib can help us to understand the alienation of pregnant women who are treated in a standardized manner, as “rushed” and “processed” through medical appointments, not even knowing if their own obstetrician will be attending their birth.[16] Moreover, it can make greater sense out of problems such as disparities in maternal outcomes within countries such as the United States where Black, American Indian, and Alaska Native women experience up to 3.2 times higher rates of pregnancy-related mortality than white women.[17] Given that they are attended by obstetrician–gynecologists certified by the American College of Obstetricians and Gynecologists (ACOG) we might presume that their outcomes would be more comparable. ACOG largely attributes these disparities to systemic economic inequalities—ageneralizable problem beyond their control. However, they do acknowledge that practitioner’s social and demographic biases may impact their recommendations for cesarean delivery. In addition, they explain that cultural and language differences may  cause “subtle ambiguities in practitioners’ and patients’ interpretations of medical information” and that a “culturally derived mistrust of the health care system may result from legacies such as coercive sterilization of poor women of color.” It is hopeful to see ACOG recognize the connection between improved health outcomes and attention to theconcrete differences between patients, even if the specific solutions that they offer are strikingly unimaginative.[18] Benhabib provides a complimentaryunnecaesareans and forced sterilization. Meanwhile other women receive little to no medical care at all, such as those in Sub-Saharan Africa and Southern Asia, where approximately 86% of maternal deaths in the world occur.[20] Feminist resistance requires continually uncovering our ignorance about the injustices faced by women of other social locations. As Villarmea writes: “We need to address the multiplicity of voices on childbirth, their autonomy and agency, and we can advance knowledge in this area by using the feminist research frameworks of embodied philosophy to determine what works, for whom and under which circumstances.”[21] In this article, Villarmea offers a provocative hypothesis: “that the very survival of patriarchy itself is closely linked to a certain understanding of and approach to care during pregnancy, labour, and birth”[19] I want to follow her boldness and propose that one of the ways patriarchy prospers is to divide women (and other genders) by class, race, geography, nationality, ability, culture, and more. When it comes to obstetric violence, many women are rightly concerned with overmedicalization such as Works CitedThe Feminist Philosophy Reader (pp. 705-718). Boston: McGraw Hill. Alcoff, L. M. (2008). How is Epistemology Political? In A. B. Cuomo,The New Organon. New York: Cambridge University Press. Bacon, F. (2000).The Feminist Philosophy Reader (pp. 478-496). New York: McGraw Hill. Benhabib, S. (2008). The Generalize and the Concrete Other. In A. B. Cuomo,The Flight to Objectivity: Essays on Cartesianism and Culture. New York: SUNY Press. Bordo, S. (1987).Witch-Hunting, Magic and the New Philosophy. Atlantic Highlands, N.J.: Humanities Press. Easlea, B. (1980).For Her Own Good. New York: Anchor/Doubleday. English, B. E. (1979).The English Works of Thomas Hobbes. Darmstadt. Hobbes, T. (1966). Philosophical Rudiments COncerning Government and Society Vol. II. In E. S. Molesworth,Coming to LIfe: Philosophies of Pregnancy, Childbirth and Mothering (pp. 193-214). New York: Fordham. Johnson, C. (2013). The Political "Nature" of Pregnancy and Childbirth. In S. L. Lundquist,Mad Mothers, Bad Mothers, and What a 'Good' Mother Would Do: The Ethics of Ambivalence. New York: Columbia University Press. LaChance Adams, S. (2014).Of Woman Born. New York: Bantam. Rich, A. (1976).Open Research Europe. Villarmea, S. (2021). A philosophy of birth: if you want to change the world, change the conversation.Hypatia: A Journal of Feminist Philosophy, 36(1), 22-41. Villarmea, S. (2021). Reasoning from the Uterus: Casanova, Women's Agency, and Philosophy of Birth.Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood. New York: Anchor. Wolf, N. (2001).https://www.theguardian.com/higher-education-network/2015/jan/05/philosophy-is-for-posh-white-boys-with-trust-funds-why-are-there-so-few-women Accessed August 11, 2021 [1] “’Philosophy is for posh, white boys with trust funds’ Why are there so few women in philosophy?” Rebecca Ratcliffe and Claire Shaw, The Guardian, January 5, 2015, [2] By referencing the female body here, I am strictly referring to the reproductive organs that are typically considered female in human and non-human animals—uterus, eggs, and so on. I am not asserting that gestational bodies must be “female” in any other respect. Nevertheless, some of the issues here may arise from the identification of pregnant bodies as female and what it means, culturally, to be identified as a woman or girl. These issues are obviously far more complex that I can discuss here, but I hope to undertake them in future work. [3]  [4]  [5] See for example: Villarmea, Reasoning from the Uterus: Casanova, Women's Agency, and Philosophy of Birth, 2021. See also note 4. [6]     [7]  [8]  [9]  [10] Emily Martin, “The Egg and the sperm: How science has constructed a romance based onSigns Vol. 16 No. 3 (1991): 485-501. stereotypical male-female roles,” [11]  [12]  [13]  [14]  [15]  [16] https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html [17] Accessed August 17, 2021https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/12/racial-and-ethnic-disparities-in-obstetrics-and-gynecology [18] Accessed August 24, 2021 [19] https://www.who.int/news/item/19-09-2019-maternal-deaths-decline-slowly-with-vast-inequalities-worldwide [20] Accessed August 17, 2021https://www.who.int/news/item/16-08-2016-true-magnitude-of-stillbirths-and-maternal-and-neonatal-deaths-underreported   Accessed August 20, 2021 [21] Is the argument persuasive and supported by appropriate evidence?YesIs the work clearly and cogently presented?YesIs the topic of the essay discussed accurately in the context of the current literature?YesDoes the essay contribute to the cultural, historical, social understanding of the field?YesReviewer Expertise:Feminist Philosophy, Philosophy of Motherhood, Ethics, Existential PhenomenologyI confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.