The Medicalization of Maternal and Childbirth Care

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Medicalization of Female Bodies

Women’s bodies have been medicalised over time not only because of gender inequality but also social structure and factors.[1] Especially, when it comes to maternal and reproductive cares, women’s bodies and rights to make decisions over own bodies and own babies are controlled by society, particularly patriarchy society.

Historical Birthing Position

Oldest records of parturient positions are in “an upright posture, usually squatting or kneeling.”[2] At the time when Cleopatra (69 - 30 BC) gave a birth, she was in a kneeling position, surrounded by only female attendants. The first birthing chair was invented in the Babylonian culture (2000 BC)[2]. In 1961, a survey conducted in 76 traditional cultures show that only 18 percent of women took a horizontal (either prone or dorsal) birthing position. [3] Still in many of developing countries, traditional birth position is preferred to horizontal birthing position which is commonly practiced prominently in Western countries.[2]. Horizontal birthing position was brought by male surgeons and was penetrated in developed countries.

Change in Child Delivery Scene

Women’s birthing position does not looks effective and comfortable for women. A scholar asserted that the change is a result of inter-professional struggles of surgeons and midwives and a maternal birthing position was implemented without verifying its appropriateness.[2] There are said to be various views on the reason behind the “evolution” of maternal birthing position. The most influential theory of triggering this change is considered to be the influence of the famous surgeon-obstetrician Ambroise Paré (1510-1590).

Ambroise Paré and Male Surgeons

Paré had no formal university education and based his knowledge rather on experiences.[4] Despite his lack of knowledge in classical theory on medicine, he established his status with his skills on obstetric cases and became able to compete with midwives.[2] [4] At that time, most surgeons did not train well thus their social status was as low as that of shoemakers and other members of guilds [2]. It was hard for them to permeate their skills on obstetric cases due to the lowness of their status and the belief that exposing women’s bodies to men was obscene. Yet, the increase of cases such result in fetal and/or maternal morbidity or mortality made reasonable for surgeons to enter into the medical field of births.[2] Then they began to find a way to reasonably and appropriately remain at births. Surgeon noticed that if women had seen pregnancy as illness, it was normal for them to intervene labour with disease prevention and/or treatment.[2]

Use of Reclining Bed

Jacques Guillemeau (1550-1613) was the pupil of Paré and a believer of the idea that pregnancy is an illness by claiming that “pregnancy, …, was a ‘tumor of the Belly’ caused by an infant …’[2]. This idea had let more surgeons to participate in labour and drive midwives out. In 1598, Guillemeau advocated reclining bed birthing, believing that reclining position would help women to feel comfortable at births and attendants to facilitate labour.[2] Reclining position was best to be used at difficult and complicated births and later spread as normal practices as well. By the end of 17th century, labour on the bed had been considered as common in France other than rural area.[2]

King Louis XIV

One of claims in regard to the change in birthing position was at the whim of King Louis XIV (1638-1715). It was reported that Louis enjoyed watching women in labour and got frustrated that he was not able to see clearly when it was occurring on a birthing stool. Therefore he demanded for change of the position to the new reclining position and for the use of the male accoucheur attending births.[2] The new reclining position was reportedly similar to the position for lithotomy operations, yet a precise relation between them are not clear.

Concern

Due to medicalization of maternal and childbirth care, maternal autonomy over their own bodies, which is the most import aspect of childbirth, has been often left out.

Psychological Support

Some scholars have been researching on mothers’ experiences in childbirth practices and improvement of maternal care.[5] [6] The experiences of childbirth significantly vary by wealth and cultures.[7] Unfortunately, mothers from lower-income family have less positive experiences and higher morbidity and mortality rate due to the lack of financial support.[7] In the most Western countries, medical intervention and use of modern technologies are relatively common; whereas, Japanese women utilise intervention that are available in most of hospitals at a very low level.[5]

Policy Making

Some researchers criticized that policy makers have focused on statistics rather than reproductive autonomy to women. For example, Multifetal Pregnancy Reduction (MFPR) (also known as selective reduction or selective termination) was created in order to save mathers who are in a mutifetal pregnancy by reducing the number of fetuses yet in some cases, mothers will and decisions were ignored. [8]. Yet, some researchers have pointed out that it is hard to reform any policies since when any kinds of reforms can threaten profits, private providers may act to undermine reforms in the implementation processes.[7]

References

  1. ↑ Wray, Sharon & Deery, Ruth. (2008). "The medicalization of body size and women's healthcare", Health Care for Women International, 29(3), 227-243.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 Dundes, Lauren. (1987). "The Evolution of Maternal Birthing Position", American Journal of Public Health, 77(5), 636-641.
  3. ↑ Naroll, Frada. (1961). "Position of women in childbirth: A study in data quality control", American Journal of Obstetrics and Gynecology, 82(4), 943-954
  4. ↑ 4.0 4.1 Dunn, Peter M. (1994). "Ambroise Paré (1510-1590):surgeon and obstetrician of the Renaissance", Archives of Disease in Childhood, 71, F231-F232.
  5. ↑ 5.0 5.1 Behruzi, Roxana et al. (2010). "Facilitators and barriers in the humanization of childbirth practice in Japan", BMC Pregnancy and Childbirth, 10(25)
  6. ↑ Peñacoba-Puente, Cecillia et al. (2016). Evolution of childbirth expectations in Spanish pregnant, Applied Nursing Research, 29, 59-63
  7. ↑ 7.0 7.1 7.2 Ewig, C. & Palmucci, G. A. (2012). "Inequality and the politics of social policy implementation: Gender, age, and Chile’s 2004 Health Reforms", World Development, 40(12), 2490-2504.
  8. ↑ Purdy, L. (2004). "Women's reproductive autonomy: medicalisation and beyond", Journal of Medical Ethics, 32(5), 287-291.
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