Below is an excerpt of my working paper on the medicalization of childbirth.
History of North American Childbirth
It is hard to imagine, but until recently, hospitals were not thought of, or utilized as, the primary facilities to birth babies. Even the presence of a physician during childbirth was unheard of in the United States until after 1750, when the introduction of forceps and pain reducers from Europe for middle and upper class women in America. During the 19th century a majority of births happened at home with only wealthier women having a physician in attendance and southern blacks as well as immigrants depending on midwives. Hospitals were relegated to the homeless or women that could not have home assistance and were noisy and dirty places operated by non-profit organizations and government (Treber & Thomasson, 2007). During the early 20th century, the status and use of hospitals dramatically changed (Treber & Thomasson, 2007). Once considered for the poor, advances in technology and changes in physician training (leading to a professional preference for hospitals), increased consumer confidence and changed the status of hospitals (Treber & Thomasson, 2007).
Treber and Thomasson (2007) state that the overall rise in hospital usage mirrors the transition from home to hospital births. In the United States, by 1935, 75% of urban births and 50% of all births happened in hospitals, keep in mind; only 5% of all births took place in hospitals in 1900 (Treber & Thomasson, 2007). One would think that this transition from home to hospital-based childbirths was results driven, but it was not the case. Maternal mortality rates (maternal deaths per 100,000 births) did not decline until the 1930’s (Treber & Thomasson, 2007). With the rise of hospital birthrates, between 1915 and 1929, infant mortality rates increased approximately 50% (Treber & Thomasson, 2007). Many believe the increased infant mortality rates were due to operative interventions on the part of physicians. Maternal mortality rates due to infection and anesthesia increased with operative interventions (Treber & Thomasson, 2007).
If the transition to physician attended and/or hospital based birth had not improved maternal or infant mortality rates, why did such a transformation from home to hospital births occur? The status of hospitals changed with the onset medical education reforms and advances in technology (Treber & Thomasson, 2007). Yet these advances yielded few results in the arena of childbirth. But as physicians developed a preference for hospital-based care, choices were limited and more births occurred at hospitals. In the end, many theorize that an increase in physician attended hospital births were financially inspired and based on supplier-induced demand (Treber & Thomasson, 2007). Physicians of the time even went so far as to blame maternal mortality rates on the incompetence of midwives and encouraging legislation that limited their access to pain medication, to in a sense beat out the competition (Treber & Thomasson, 2007).
In Canada during the 19th century, home-based and midwifery attended childbirth was replaced with the medicalization of childbirth. Canada saw a campaign similar to that in the United States, whereby financially motivated Physicians discredited the skills of midwives (Macdonald, 2006). Childbirth was redefined and transformed into a medical event and by the 1940’s; midwifery was no longer an option for a majority of Canadian women (Macdonald, 2006).
Medicalization of Childbirth
The term “medicalization” has a wide variety of meanings. Generally defined as “the redefining or re-conceptualizing of nonmedical behaviors, experiences, or problems as medical in nature” (Brennan, 2010). Brennan (2010) states that medicalization, even more simply put, is “to make medical”. It is more like widening the category of illness and disease and narrowing what is considered normal and healthy. Used in most instances to describe unnecessary medical intervention and viewed by sociologist as using medicine as a tool in social control.Medicalization of childbirth is a problem faced by privileged women and developed nations.
According to Walsh (2009), as women’s views of natural childbirth and pain during labor change, so has the use of epidurals during low-risk pregnancies. From 1989 to 2008, epidural rates in the UK doubled from 17% to 33%. In part due to the move from home the hospital births and the coinciding medicalization of the response to labor pain. Though women are told to avoid all and any unnecessary drugs during pregnancy sentiments quickly change during delivery. The side effects of epidurals can vary from the lengthening of labor, to hypotension and even increased third and fourth degree tears. Though childbirth is considered a “rite of passage” in indigenous societies, many with poor maternal mortality rates, women in developed nations who have safer pregnancies face “tokophobia”. Varying degrees of Tokophobia or morbid fear of labor and the associated pain maybe the reason that risk adverse women are willing to utilize various forms of intervention from induction to epidurals (Walsh, 2009).
In some parts of the world rates of cesarean births have increased to over 50%, despite the lack of evidence of any increase in childbirth emergencies (Armson, 2007). Armoson (2007), states that cesarean births in Canada rose from 5.2% in 1969 to 25.6% in 2003. The perceived benefits of cesarean births have in part led to the trend of the planned c-section for low risk pregnancies. Many women are choosing cesarean births in place of vaginal births due to anxiety about the pain of childbirth. Many women also believe that this method of childbirth a will lead a higher likelihood of a successful delivery. In response to the increased perceptions of cesarean births being safer, further research was done in relation to maternal morbidity. Due to increased risk of arrest, hematoma, hysterectomy, infection and other complications, risk of severe maternal morbidity was 3.1 times great than planned vaginal births (Armson, 2007). Though absolute increases of severe maternal morbidity rates in planned cesarean birth were small, had the highest in hospital mortality and morbidity rates (Armson, 2007).
Dr. Linda B Tiedje, an Adjunct Associate Professor at the Michigan State University School of Human Medicine and Dr. Elizabeth Price, a Nurse Practitioner sought to examine women’s opinions and response to the changes in modern childbirth and delivery. Data was based on twelve mostly middle class, educated, white women from the mid-west who were interviewed three postpartum. The sample reflected an 80% epidural rate, 33% cesarean rate with all the women having fetal monitoring. Tiedje and Price (2008) discussed what was now considered the normal childbirth experience, which included technology, caesarean births and a great deal more monitoring and intervention. The shift to the aforementioned birth experience norms was attributed to a change in both patient and provider behavior. The women’s perception and acceptance of “high-tech” and “high-touch” (versus natural and un-medicated) care was due to their perception of three major themes: trust, control, and information. With all the changes in childbirth and delivery, their acceptance of said changes was based on a feeling of personal choice (Tiedje & Price, 2008).
Over the past 30 years, what is being considered a feminist movement against the medicalization of childbirth has been taken place in Britain. Considering 99% of British births occur in hospitals, the prevalent view is that hospitals are the safest and most appropriate place to give birth (Crossley, 2007). Though hospitals and physicians can give the illusion of choice, many feminists believe the “medical gaze pathologies the birth process and undermines women” (Crossley, 2007). The new trend of idealizing pre-medical childbirth is a change of previous views by women in which the embrace of medical intervention was a freedom from the pitfalls of biology. A movement which once considered why should women experience the pain of labor now wonders why women’s bodies are being painted incapable of childbirth without the help of a patriarchal medical community (Crossley, 2007).
At 7.8 deaths per 100,000 live births, Canada has the lowest maternal mortality rates in the Americas and the world (Johnson, 2008). These numbers are attributed to higher levels of education, economic stability and a strong health care system. But according to Johnson (2008), Canadian women feel as though they are under constant medical watch. They feel disempowered by the entire medicalization of both their prenatal care and labor and delivery. The constant monitoring of physical stats/numbers by medical professionals and the pressure of pharmaceutical companies as well as general marketers to gauge and manage normality during pregnancy takes a psychological toll. Whether a pregnancy or medical history dictates it, a pregnant woman in a developed nation requires a whole gambit of blood tests and ultrasounds (Johnson, 2008).
Even with all the aforementioned dialogue, the “problem” of medicalization is one of privilege. Not one often faced by poor women in developed nations or underdeveloped nations (Johnson, 2008). Disadvantaged populations are the least “medicalized”. There is in fact a call for more medical intervention in developing nations in hopes of improving infant and maternal mortality rates. There are higher maternal mortality rates for African-American women as well as a similar trend for indigenous Australian and Canadian populations (Johnson, 2008). Home-births in America and United Kingdom with traditional midwives and other birth support specialists such as Doulas are becoming a sign of privilege, status and a sort of enlightened symbol. These women are viewed as more in control of their bodies and medical care (Johnson, 2008).
Armson, B. A. (2007). Is planned cesarean childbirth a safe alternative? CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 176(4), 475-476. doi:10.1503/cmaj.061724
Brennan, R., Eagle, L., & Rice, D. (2010). Medicalization and marketing. Journal of Macromarketing, 30(1), 8-22. doi:10.1177/0276146709352221
Crossley, M. L. (2007). Childbirth, complications and the illusion of `Choice': A case study. Feminism & Psychology, 17(4), 543-563. doi:10.1177/0959353507083103
Johnson, C. (2008). The political “Nature” of pregnancy and childbirth. Canadian Journal of Political Science/Revue Canadienne De Science Politique, 41(4), 889-913. doi:10.1017/S0008423908081079
Macdonald, M. (2006). Gender expectations: Natural bodies and natural births in the new midwifery in Canada. Medical Anthropology Quarterly, 20(2), 235-256. doi:10.1525/maq.2006.20.2.235
Tiedje, L. B., Price, E., & You, M. (2008). Childbirth is changing: What now? MCN. The American Journal of Maternal Child Nursing, 33(3), 144-150. doi:10.1097/01.NMC.0000318348.62740.94
Treber, J., & Thomasson, M. A. (2007). From home to hospital: The evolution of childbirth in the United States, 1928-1940. EXPLORATIONS IN ECONOMIC HISTORY, 45(1), 76-99. doi:10.1016/j.eeh.2007.07.001
Walsh, D. (2009). Pain and epidural use in normal childbirth. Evidence-Based Midwifery (Royal College of Midwives), 7(3), 89.