Imagine that you or a loved one has been trying to have a baby for years and you have just discovered you or she is pregnant. This is one of those magical moments in your life, a very personal and sacred experience. What images come to mind? Forty weeks of excited bliss? Bonding with your closest friends as you witness those foetal kicks?
And what of the birth? Do you picture those first few minutes after the child has been born? When you finally have the opportunity to breathe in the smell of that new baby? These are among the greatest parts of the reproductive process, and yet in our society we loom dangerously near to removing some of these from reproduction entirely. For many women the actual experiences of pregnancy and childbirth are riddled with feelings of fear, doubt and anxiety. Many women are not given the opportunity to meet their child in those first few moments of her life. How can this be happening? This is the result of a process I refer to as the medicalisation of reproduction.
In this process pregnancy and childbirth are perceived as medical problems rather than natural elements of the human life-cycle.[i] Technological intervention is then employed to “treat” pregnant women. Frequently individual knowledge and experience become devalued and replaced with the “expertism” of professionals.[ii] You may well ask: what’s wrong with this? Professionals know what they’re doing, surely it is safer for individuals to put their trust in experts when having a child? The reality is; experts do not always know best. This paper will focus on instances when professional know-how has been acted upon at the expense of the individual. These instances are not as rare as one would hope, which is not to say that doctors are inherently untrustworthy, or that there is never reason to call upon professional assistance during the reproductive process. Rather I hope to challenge popular beliefs that technological intervention is always necessary to pregnancy and childbirth. I wish to expose the negative implications that these beliefs can have for doctor-patient relationships. I want to demonstrate how the medicalisation of reproduction encourages a climate of distrust between individuals and the professionals they have been told they can trust.
When considering the relationship between medical professionals and pregnant women it is evident that trust is bound to reciprocity. It is difficult for trust to exist between a medical professional and a patient if it is not mutual. Indeed in the medicalisation of reproduction an experts lack of trust in her or his patient, can lead to an abuse of their patients trust. One example of this takes place if a doctor fails to give weighty consideration to a pregnant woman’s concern about having a particular procedure and goes forth without her explicit consent, which, as shall be explored in greater detail shortly, has been the case for some patients.
Individuals have to place a certain degree of trust into members of the health services, such as general practitioners, nurses, obstetricians, and midwives, in order for these professionals to carry out their work effectively. However, it appears that this level of trust is continually rising to the point where individuals are expected to float passively through their experiences of pregnancy and childbirth accepting guidance as gospel. [iii]
This phenomenon can be attributed to an emerging culture of “expertism”.
Fundamental to the medicalisation of reproduction is an elitism that declares the patient’s knowledge inept. Within the politics of reproduction it appears that there is only a finite amount of trust. That is: as more and more trust is placed in reproductive experts the less there is in the patient’s knowledge. This, once again, begs the question: is placing trust in an “expert” necessarily a negative factor? Surely a professional who has studied the human reproductive system, and who devotes forty plus hours a week to observing and advising pregnant women, can be trusted to know what is best for their patient? This knowledge counts for very little to the pregnant woman whose voice is either ignored or dismissed, or the patient whose bodily integrity is compromised in the name of clinical routine. As one woman recalling her traumatic birth experience writes:
Why did I ever trust an [obstetrician] with a yacht called “Bit of Fluff”????... He asked me to get on the bed and proceeded without my consent or any prior warning to “strip and stretch my cervix” I exclaimed “Owww!” to which he replied, “Oh yes, I just did a strip and stretch. We should see this baby within 24 hours,” I was horrified and scared.[iv]
And another woman stated:
A registrar did an internal and announced, [“]you’re one centimetre dilated and I’ve stripped your membranes[”](excuse me, don’t you ask for consent before doing a procedure?).[v]
In both these examples a procedure was carried out without the patients consent or even her knowledge. These women know better than most that an obstetrician’s understanding of the body’s mechanics means little to a patient without trust. Implicit to both these examples is the assertion that reproductive experts do not believe their patients can be trusted to know what is in their own interests. The pregnant woman may not be a highly trained scientist, as such it is assumed that by entering a relationship with a medical professional she has given implicit consent to whatever procedures that professional deems necessary. Her explicit consent and sometimes even her awareness are inconsequential.
This distrust of the pregnant woman has been demonstrated by instances where women have been either physically forced or legally constrained to undergo certain medical procedures.[vi] In her article “Foetal rights: more than a mother can bear?”[vii] Journalist Louise Chunn cites a case in the
A recent article in The Age would have readers believe that pregnant women are demanding these high-risk, invasive medical procedures against their doctor’s wishes. However it also states that only between 5 and 10% of women giving birth throughout the entire country request caesarean sections.[xii] How does The Age account for the remaining 35 to 40% of women giving birth at the Royal Women’s Hospital?
There are times when caesareans are a necessary procedure to ensure the health of the pregnant woman and her child. I do not wish to suggest that caesareans should be outlawed or that no caesarean has ever saved a patients life. However, there is a particularly high rate of caesarean births in
When aware of the emotional and physical risks associated with caesarean births for both mother and child, most women would favour the vaginal option. As pregnancy and childbirth are increasingly conceptualised as illnesses to be dealt with by technological intervention, vaginal births are becoming a right women must attempt to claim as opposed to the accepted norm. The following testimonies are from women who have suffered birth-trauma as a result of coercion to accept caesarean sections. These accounts illustrate how birth-trauma can be the result of an abuse, or lack, of trust between medical professionals and pregnant women. To protect the identities of these women, who have generously shared their experiences with me for the purpose of this paper, I have used pseudonyms.
Melissa:
[The obstetrician] suggested a c-section as soon as she could…There was no reason for one, except that she was concerned about me and it didn’t occur to her or to the obstetric nurse on duty that preventing me from taking in food or drink might be contributing to my fatigue or that I might have continued to progress if they hadn’t confined me to a bed on my back. In the end, two scalp blood samples from my daughter sent her into extreme distress.[xiii]
Nesam:
The doctor was angry with me from the start as I didn’t go straight in when my waters broke, then I refused the epidural which they thought I needed… I really only saw [the doctor] the one time when she checked dilation and then after about thirteen hours, when the induction hadn’t worked and we were waiting because all contractions had stopped. She just walked in and said; “right we’ve tried everything you are having a c-section”.[xiv]
Simone
At
Jan:
The OB[stetrician] came back at around 10AM and told me that if my blood pressure didn’t go down I would have to have a caesarean and he said he would give me a bit longer to see how I go…[At 11am he] came in and told me he had already called the anaesthetist and the theatre was being prepped for me. [he] now told me my only real option was a caesarean and I had absolutely no idea what was happening and agreed to the caesarean.[xvi]
Louise:
[The obstetrician] said “So you had a c section last time, you will be having one again” I practically yelled “NO!” At this point she lent back in her chair, rolled her eyes and sighed in a manner which definitely said to me “Oh no, another one who thinks they can do it naturally,”.[xvii]
Hilary:
I never consented, not once. They have a signed consent form alright, but I was tricked into signing that three days earlier, when devastated by the fact that I was pushed into booking the unwanted c/sec, the ob[stetrician] told me I needed to sign a booking in sheet. It was in fact the consent [form]. Regardless of that, I had actually told them I didn’t want this….I STILL DON’T CONSENT.[xviii]
Nicole:
I could see the reflection of them painting my belly with that yellow stuff. My husband thought it looked like they were basting a turkey. And that turkey was me…. It seemed to take so long. Then finally my firstborn was pulled from me and I looked up to see him come out…I cried. Not because of sheer joy, but because of [the] sense of detachment I felt. My second child I birthed with a different
Many pregnant women live in fear of having caesarean sections, particularly those who have had them previously. These women often find it difficult to trust medical professionals attending their births because of a perceived pressure to be obedient and not to inconvenience the doctor anymore than is necessary.[xx] Indeed one woman who shared her experiences with me stated that she felt ‘like an egg under a timer.’[xxi] This environment is clearly a breeding ground for distrust between health care providers and patients.
Without reciprocal trust in such a relationship, health is difficult to maintain. A woman could become hesitant to share her experiences and concerns with her doctor, which could be detrimental to her well-being. Furthermore her emotional and psychological strength are central to healthy reproduction. Without a trusting relationship with her health care provider the pregnant woman may struggle to create the necessary conditions for successful childbirth.
The medicalisation of reproduction relies heavily upon technological interventions, such as caesarean sections. In perceiving pregnancy and childbirth as clinical dilemmas medical experts look to technological means of “treating” these experiences. The medical profession’s primary concerns are improving the health of those who are sick, finding break-through solutions, and alleviating pain[xxii] and suffering. Pain, to medicine, is pathological, however pain in childbirth is natural.[xxiii] The role of the doctor in dealing with say a heart disease patient is necessarily active, while the patient is helplessly passive. The failing heart requires technological assistance because it can no longer function effectively. As a result of the medicalisation of reproduction the pregnant woman is increasingly conceptualised as the failing heart. In contrast to the patient suffering a heart attack the pregnant woman is an incredibly active patient. In many instances throughout history, and in some parts of the world today, birthing women have been both doctor and patient during labour.
Historically pregnancy and childbirth have sometimes been difficult and risky experiences for women, and it is often argued that it is because of the medicalisation of reproduction that women stand a much better chance of experiencing a healthy, uncomplicated childbirth.[xxiv] The problem is the degree and extent of this medicalisation. Today many people believe it is irresponsible to give birth outside a hospital. There have been lawyers who have pushed for women who plan home-births to be convicted of child-abuse.[xxv] Pregnancy and childbirth should be approached from the understanding that they are natural experiences that women’s bodies are designed to do effectively. The reality is that the majority of women do not need intervention or technological assistance to give birth.[xxvi] But there is a huge lack of trust in women’s abilities to reproduce properly without technological intervention, or obsessive monitoring. A fact that too many people struggle to grasp is that women’s bodies are all the technology required.
Society’s lack of trust in women to adequately care for their foetuses without technological intervention is highlighted by the existence of certain pamphlets supposedly designed to help pregnant women. One such pamphlet is a seventeen page booklet entitled A guide to tests and investigations for “uncomplicated” [my emphasis] pregnancies.[xxvii] How many more pages need be added should the woman become anxious about the state of her and her unborn child’s health? This pamphlet is accompanied with cartoons of pregnant women lying or sitting down while a doctor towers over them carrying out which ever test is relevant to that page. The pregnant woman smiles happily while the doctor wears a serious face, in one cartoon the doctor’s eyes are closed and her nose lifted high in the air. The message sent to pregnant women is clear: sit still, smile politely, the doctor is busy making a baby.
One technological intervention that has become a routine practice and is today synonymous with pregnancy is the ultrasound. Readers may be shocked to learn that it has never been established that ultrasounds are safe.[xxviii] Quite the contrary, many researchers have found evidence to suggest that the risks far outweigh the potential benefits. Studies have shown that ultrasounds increase the risks of newborns having low birth-weights[xxix], increased risk of retarded foetal growth[xxx] and postnatal mortality.[xxxi] When exposed to ultrasound adult mice experienced impaired brain function.[xxxii] And another study showed that children who had been exposed to ultrasound in utero were twice as likely to have speech problems than those who had not.[xxxiii]
According to the World Health Organization:
Ultrasound screening during pregnancy is now in widespread use without sufficient evaluation. Research has demonstrated its effectiveness for certain complications of pregnancy, but the published material does not justify the routine use of ultrasound in pregnant women. There is also insufficient information with regard to the safety of ultrasound use during pregnancy, including: clinical effectiveness, psychological effects, ethical considerations, legal implications, and safety.[xxxiv]
The medicalisation of reproduction is a dangerous phenomenon. This paper has considered but a few examples of how this process can be detrimental to both the physical and psychological health of women and, in some cases, their foetuses.
It is also important to consider that the negative effects of the medicalisation of reproduction are not restricted to patients. Health service providers could find their jobs becoming increasingly difficult due to a lack of trust from their patients. Mutual trust between health care providers and patients should not be permitted to deteriorate. It must be fostered and encouraged. Only then will complete health be a possibility for pregnant women. The first step is to start conceptualising reproduction, and the functions women’s bodies perform in reproduction, as natural and healthy conditions. Furthermore we need to treat pregnant women, and indeed encourage pregnant women to perceive themselves, as experts of their own bodies
Finally I wish to challenge readers to see pregnancy and childbirth as the natural wonders that they are, rather than medical problems to be overcome or solved by technology. I challenge you to enjoy these experiences and refuse to fear. I leave you with the words of a new mother overcoming her traumatic birth experience:
In hindsight, what have I learned?...That I am STRONG, that birth is NOT painful. It is sexy, powerful, full of love, and is a journey to help you learn to put faith and trust in YOURSELF![xxxv]
[i] Janice G. Raymond, Women as Wombs: Reproductive Technologies and the battle over Women’s Freedom,
[ii] For more on “medicalised birth” see Marsden Wagner MD MSPH, Fish Can't See Water: The Need to Humanize Birth in Australia, 28 July 2002 [cited 13 July 2005. Available from http://www.acegraphics.com.au/articles/wagner03.html See also Marsden Wagner MD MSPH, The Active Management of Labour, December 4 2002, http://www.acegraphics.com.au/articles/wagner01.html, last accessed 13 July 2005.
[iii] See Wagner, The Active Management of Labour.
[iv] Anonymous, Personal Communication,
[v] Anonymous I, Personal Communication,
[vi] See Susan Bordo, Unbearable Weight: Feminism, Western Culture, and the Body,
[vii]Louise Chunn, “Foetal Rights: more than a mother can bear?” Elle, July, 1988, pp.33-34.
[viii] In Ibid, p.124.
[ix] “Birth is not an illness: The Fortelesa Declaration, WHO 1985” Birth Matters, Volume 7.3, September, 2003, p. 16.
[x] “
[xi] Royal Women’s Hospital Obstetric Statistics, March 2005, http://www.rwh.org.au/maternity/ObStats.htm Last Accessed 19 May 2005.
[xii] "
[xiii] Personal Communication,
[xiv] Personal Communicaiton,
[xv] Personal Communication,
[xvi] Personal Communication,
[xvii] Personal Communication,
[xviii] Personal Communication,
[xix] Personal Communication,
[xx] See The Brighton Women and Science Group “Technology in the Lying-in-Room” in Birke, Lynda et al
[xxi] Personal Communication, 22 May 2005.
[xxii] Sarah Eaton, “The Medical Model of Reproduction”, New Antigone, vol 1, October, spring, 2005, p. 28.
[xxiii] Eaton, “The Medical Model of Reproduction”, p. 28
[xxiv] It is also important to note that there are studies that have shown that there is no relation between perinatal mortality rates and the level of medical intervention, see Marsden Wagner MD MSPH, Fish Can't See Water.
[xxv] In Robyn Rowland, Living Laboratories: Women and Reproductive Technologies,
[xxvi] Wagner, Fish Can't See Water.
[xxvii] “A guide to tests and investigations for uncomplicated pregnancies,” 3 Centres collaboration, www.3centres.com.au, last accessed April 15, 2005.
[xxviii] Marsden Wagner MD MSPH, "Ultrasound: More Harm Than Good?" Midwifery Today 50,no. Summer (1999). http://www.midwiferytoday.com/articles/ultrasoundwagner.asp?q=ultrasound. Last accessed
[xxix] J.P. Newnham, Evans, S.F.,
[xxx] M.P. Hande, & Devi, P.U. (1995). Teratogenic effects of repeated exposures to X-rays and/or ultrasound in mice. Neurotoxicol Teratol (NAT), 17(2), 179-88.
[xxxi] Ibid.
[xxxii] Devi, P.U., Suresh, R., & Hande, M.P. (1995). Effect of fetal exposure to ultrasound on the behavior of the adult mouse. Radiation Research ,141(3), 314-7.
[xxxiii] J.D. Campbell, Elford, R.W. & Brant, R.F. (1993). Case-Controlled Study of Prenatal Ultrasound Exposure in Children with Delayed Speech. Canadian Medical Association Journal, 149(10), 1435-1440.
[xxxiv] In Wagner, "Ultrasound: More Harm Than Good?"
[xxxv] Anonymous II, Personal Communication,
From http://www.joyousbirth.info/articles/medicalisation.html
