Going into Labour
Childbirth in Capitalism
By: Anna Fielder
232 pages
Paperback
ISBN-10 : 0745349498
Pluto Press
November 20, 2024
Purchase - Publisher £19.99
Reviewed by Cinderella Ochu, PhD
Childbirth in Capitalism
By: Anna Fielder
232 pages
Paperback
ISBN-10 : 0745349498
Pluto Press
November 20, 2024
Purchase - Publisher £19.99
Reviewed by Cinderella Ochu, PhD
Anna Fielder’s Going Into Labour: Childbirth in Capitalism arrives at a moment of compounding crises in global maternal health. Midwifery shortages, rising caesarean rates, and racialised maternal mortality all demand sustained analytical attention. The work meets that challenge by bringing Marxist political economy to childbirth with a rigour the field has long needed.
The book's central ambition is to show that analyses of childbearing must grapple with capitalism if we are to explain why calls for change in childbirth so often go unheeded (4). Drawing on Marx's understanding of capital—not merely as market exchange, but as a system premised on surplus-value extraction, primitive accumulation, and the subordination of human life to profit—Fielder argues that childbirth must be understood through the lens of capitalism and social reproduction. Engaging Marxist and socialist feminist scholarship, she demonstrates how pregnancy and birth are essential to capital's continuation while often remaining marginal within traditional Marxist analysis (4–5). Particularly persuasive is her argument that the physiology of birth is distinct from, yet deeply entwined with, the circuit of capital. This theoretical foundation underpins her examination of what she calls the “TREC” ensemble—technology, risk, evidence, and choice —and shapes the argument for imagining childbirth beyond the constraints of capitalist organisation.
The TREC chapters are among the book’s most compelling contributions, revealing how practices that often appear clinically neutral are embedded in broader political and economic structures. Obstetric technologies do not simply enter maternity care because they are medically useful; they also acquire authority through institutional histories that privilege intervention, efficiency, and expert control over labouring bodies (57–84). Likewise, risk emerges not as a self-evident fact of pregnancy but as a category actively produced through monitoring, clinical classification, and the unequal distribution of vulnerability in maternity systems (85–105). Fielder’s treatment of evidence is especially incisive in showing how the randomised controlled trial (RCT) became the “gold standard” of obstetric knowledge, often obscuring the social relations and embodied contingencies that exceed biomedical measurement (106–24).
In her discussion of choice, she resists the easy celebration of autonomy by showing that reproductive decision-making takes place within profoundly unequal conditions (125–47). Across these chapters, the book’s central claims come into sharp focus: the authority of contemporary maternity care rests not only on medicine but also on the naturalisation of capitalist values within the management of birth.
The final chapter turns to the possibilities of resistance through birth-worker activism, solidarity economies, and anti-capitalist organising. Though more aspirational than analytical, this part of the book nonetheless feels earned by the strength of the chapters that precede it.
One of the book's most significant contributions lies in the productive questions it leaves unanswered. Fielder is explicit that her analysis is grounded primarily in English-speaking contexts, a decision shaped in part by the realities of language and location. This invites a broader inquiry: what does a Marxist analysis of childbirth look like when capitalism's operations are inseparable from the colonial and postcolonial histories that have shaped maternal health infrastructures across the Global South? Viewed through the lens of my own work on medicine, fertility, and colonialism in Nigeria, Fielder's argument is not diminished by this question but enriched by it.
Her analysis of birth control is especially suggestive here. Fielder’s account of how capitalism alternately demands reproductive labour and seeks to curtail it connects directly to a history that her discussion of appropriation and regulation gestures toward but does not fully develop: the racialised and imperial dimensions of birth control's introduction in postcolonial Africa. Across much of postcolonial Africa, international family-planning programmes funded by organisations such as the Rockefeller Foundation, the Ford Foundation, and the Population Council have often been met with suspicion because many nationalists have understood them as continuations of imperial power by other means. What appears in the Global North as a contradiction internal to capitalism's demands often emerged in postcolonial Africa through the language of development expertise and international intervention. Read in this context, Fielder's analysis reveals how birth control has functioned not only as a response to perceived pressures on population growth but also as a tool of rule shaped by enduring colonial hierarchies. Her account of capital’s contradictory demands upon reproduction is especially useful for thinking through these histories, even as they point toward the need for a more explicitly postcolonial political economy of birth.
Fielder’s discussion of the “new reproductive technologies” turn is equally generative. Although childbirth remains her primary focus, the argument she develops offers valuable tools for thinking about in vitro fertilization, egg freezing, surrogacy, and other assisted reproductive technologies. In contexts such as Nigeria, where fertility services have expanded more rapidly than regulatory oversight, these interventions reveal how reproductive futures are increasingly shaped by market logics while remaining deeply stratified by class. They illuminate not only the commodification of reproduction but also the uneven distribution of reproductive possibility. A postcolonial state that once regulated indigenous midwifery under colonial rule has yet to establish a comprehensive national legislative framework for assisted reproduction. The implications of this regulatory gap for reproductive justice are better understood through Fielder's analysis. However, the framework could be extended by tracing how colonial histories of population control and reproductive governance continue to shape these contemporary inequalities. This is less a criticism of what the study omits than a measure of what it makes possible: the work opens avenues of inquiry beyond the contexts it directly examines.
The book does not resolve every contradiction it so carefully maps. As Fielder herself acknowledges, invoking Fredric Jameson, "History hurts." The labours of childbirth, like the labours of capital, are shaped by forces that are far from benign, and Fielder offers a robust vocabulary for understanding them. She shows that pregnancy and birth are neither purely biological events nor merely clinical encounters, but historical processes deeply entangled with the organisation of contemporary life. For scholars of pregnancy, birth, social reproduction, and the history of medicine, Going Into Labour offers not only a compelling analysis of the present but also a conceptual framework for future scholarship.
Cinderella Ochu, PhD, is a Lecturer in the Department of Anthropology at Tufts University, where she teaches Medical Anthropology.
Date of Review: July 20, 2026
How to cite this review:
Ochu, Cinderella. Review of Going Into Labour: Childbirth in Capitalism. Anna Fielder. London: Pluto Press, 2024. Society for the Study of Pregnancy and Birth Reviews, July 2026. https://www.ssprb.org/book-review-going-into-labour.html.
The book's central ambition is to show that analyses of childbearing must grapple with capitalism if we are to explain why calls for change in childbirth so often go unheeded (4). Drawing on Marx's understanding of capital—not merely as market exchange, but as a system premised on surplus-value extraction, primitive accumulation, and the subordination of human life to profit—Fielder argues that childbirth must be understood through the lens of capitalism and social reproduction. Engaging Marxist and socialist feminist scholarship, she demonstrates how pregnancy and birth are essential to capital's continuation while often remaining marginal within traditional Marxist analysis (4–5). Particularly persuasive is her argument that the physiology of birth is distinct from, yet deeply entwined with, the circuit of capital. This theoretical foundation underpins her examination of what she calls the “TREC” ensemble—technology, risk, evidence, and choice —and shapes the argument for imagining childbirth beyond the constraints of capitalist organisation.
The TREC chapters are among the book’s most compelling contributions, revealing how practices that often appear clinically neutral are embedded in broader political and economic structures. Obstetric technologies do not simply enter maternity care because they are medically useful; they also acquire authority through institutional histories that privilege intervention, efficiency, and expert control over labouring bodies (57–84). Likewise, risk emerges not as a self-evident fact of pregnancy but as a category actively produced through monitoring, clinical classification, and the unequal distribution of vulnerability in maternity systems (85–105). Fielder’s treatment of evidence is especially incisive in showing how the randomised controlled trial (RCT) became the “gold standard” of obstetric knowledge, often obscuring the social relations and embodied contingencies that exceed biomedical measurement (106–24).
In her discussion of choice, she resists the easy celebration of autonomy by showing that reproductive decision-making takes place within profoundly unequal conditions (125–47). Across these chapters, the book’s central claims come into sharp focus: the authority of contemporary maternity care rests not only on medicine but also on the naturalisation of capitalist values within the management of birth.
The final chapter turns to the possibilities of resistance through birth-worker activism, solidarity economies, and anti-capitalist organising. Though more aspirational than analytical, this part of the book nonetheless feels earned by the strength of the chapters that precede it.
One of the book's most significant contributions lies in the productive questions it leaves unanswered. Fielder is explicit that her analysis is grounded primarily in English-speaking contexts, a decision shaped in part by the realities of language and location. This invites a broader inquiry: what does a Marxist analysis of childbirth look like when capitalism's operations are inseparable from the colonial and postcolonial histories that have shaped maternal health infrastructures across the Global South? Viewed through the lens of my own work on medicine, fertility, and colonialism in Nigeria, Fielder's argument is not diminished by this question but enriched by it.
Her analysis of birth control is especially suggestive here. Fielder’s account of how capitalism alternately demands reproductive labour and seeks to curtail it connects directly to a history that her discussion of appropriation and regulation gestures toward but does not fully develop: the racialised and imperial dimensions of birth control's introduction in postcolonial Africa. Across much of postcolonial Africa, international family-planning programmes funded by organisations such as the Rockefeller Foundation, the Ford Foundation, and the Population Council have often been met with suspicion because many nationalists have understood them as continuations of imperial power by other means. What appears in the Global North as a contradiction internal to capitalism's demands often emerged in postcolonial Africa through the language of development expertise and international intervention. Read in this context, Fielder's analysis reveals how birth control has functioned not only as a response to perceived pressures on population growth but also as a tool of rule shaped by enduring colonial hierarchies. Her account of capital’s contradictory demands upon reproduction is especially useful for thinking through these histories, even as they point toward the need for a more explicitly postcolonial political economy of birth.
Fielder’s discussion of the “new reproductive technologies” turn is equally generative. Although childbirth remains her primary focus, the argument she develops offers valuable tools for thinking about in vitro fertilization, egg freezing, surrogacy, and other assisted reproductive technologies. In contexts such as Nigeria, where fertility services have expanded more rapidly than regulatory oversight, these interventions reveal how reproductive futures are increasingly shaped by market logics while remaining deeply stratified by class. They illuminate not only the commodification of reproduction but also the uneven distribution of reproductive possibility. A postcolonial state that once regulated indigenous midwifery under colonial rule has yet to establish a comprehensive national legislative framework for assisted reproduction. The implications of this regulatory gap for reproductive justice are better understood through Fielder's analysis. However, the framework could be extended by tracing how colonial histories of population control and reproductive governance continue to shape these contemporary inequalities. This is less a criticism of what the study omits than a measure of what it makes possible: the work opens avenues of inquiry beyond the contexts it directly examines.
The book does not resolve every contradiction it so carefully maps. As Fielder herself acknowledges, invoking Fredric Jameson, "History hurts." The labours of childbirth, like the labours of capital, are shaped by forces that are far from benign, and Fielder offers a robust vocabulary for understanding them. She shows that pregnancy and birth are neither purely biological events nor merely clinical encounters, but historical processes deeply entangled with the organisation of contemporary life. For scholars of pregnancy, birth, social reproduction, and the history of medicine, Going Into Labour offers not only a compelling analysis of the present but also a conceptual framework for future scholarship.
Cinderella Ochu, PhD, is a Lecturer in the Department of Anthropology at Tufts University, where she teaches Medical Anthropology.
Date of Review: July 20, 2026
How to cite this review:
Ochu, Cinderella. Review of Going Into Labour: Childbirth in Capitalism. Anna Fielder. London: Pluto Press, 2024. Society for the Study of Pregnancy and Birth Reviews, July 2026. https://www.ssprb.org/book-review-going-into-labour.html.