The medicalization of pregnancy and childbirth is an occurrence that started in the 19th century and still continues today. It is taking the normal natural occurrence of pregnancy and childbirth and making it an illness in need of medical attention. For thousands of years women have given birth safely with the help of midwives, friends, and relatives outside of hospitals. But in recent years it has become expected (98% of children are currently born in a hospital) that women are to have babies in a hospital under a physician's eye, attached to monitors, given drugs, and given episiotomies. Women are called patients and admitted to hospitals. Mortality rates have dropped for lots of reasons not just moving birthing to hospitals. Some of these reasons are prenatal care, nutrition, women's health, and the understanding of the woman's body.

Medicalization has its benefits, but it also has created many problems for women during birth.

In the hospital much of the dignity was taken from childbirth. Women also cannot control their own health and body in a hospital. Women are shaved, and sliced for reasons that have no real support. For instance episiotomies are often performed so that a woman won’t tear during birth. It's like burning down your own house so someone else won't. In studies women heal better and faster without episiotomies, have less pain during sex months later, and have more comfort in the few weeks after childbirth. They are also covered up and draped so that the doctor would only see a vagina instead of the entire woman. Pregnant women became subjects to the patriarchal world that we live in, where medicine rules over nature. Traditionally women have given birth squatting or standing, due to the medicalization of childbirth women now are forced to give birth laying down with their feet in the air (a position made popular by a rich and powerful man years ago because he wanted to stand behind a curtain and get a good look at his wife birthing their child). This position allows the doctor to stand or sit without having to put much physical effort into the birth, by bending his/her back. But the position actually makes going through the labor and childbirth more difficult for women. She must push her baby in an uphill fashion going against gravity. In the hospital, women are usually attached to machines and monitors. This is a sort of bondage for women. Her body is working extremely hard and she is stuck to the bed in what could be an uncomfortable position for her. When women have the chance they usually prefer to walk, move, bathe, and bend during labor and birth.

The reason that so many women today still have children in hospitals is because there is a lack of options, the idea that a woman won’t be able to take the pain, and that our culture does not support home births. There are fewer midwives available today. And most of us still think that all births should be under a doctor’s close watch. In actuality midwives are just as reliable if not more for low risk women. Let me repeat for low risk women. They spend an average of 50 hours with women before the actual delivery, while doctors spend an average of 5. Midwives are about 1/2 to 1/3 of the cost of doctors. They perform less C-sections, episiotomies, and other surgeries. Hollywood portrays only the most painful and difficult of childbirth and therefore women begin to think that they will not be able to take the pain. The pain may be intense, but many women today want to be alert enough to remember their delivery. With the ability to sit in warm water, and move around more women can deliver their children without drugs.

The medicalization of pregnancy is only one of the many aspects of women's health that has been turned into an illness and something that a woman can no longer control.

The medicalization of childbirth is in most cases extremely necessary.

Since the medicalization of pregnancy in the early 1900's, the infant mortality rate has decreased 90%, and maternal mortality has decreased 99%. Cosmic Cat states that for thousands of years women have been giving birth safely "With the help of midwives, friends and relatives." Judging from infant and mother mortality statistics from the past few hundred years, this is patently false. A few hundred years ago, the leading cause of death of women were childbirth complications. This is why so many ancient societies, especially in Africa, practiced polygamy; so that if a woman died during childbirth,as often happened, there would be other wives to take care of the children.

I would really, really prefer not to have my friends deliver my baby. You know who you are.

In all seriousness, I wouldn't want to force my friends or family to be responsible for a potential death. Sometimes, shit happens, and you can't do anything about it; but I'd still feel responsible if a friend of mine died under my jurisdiction-- I'd kill myself with 'what ifs'.

In places like Somalia, one in seven women die in childbirth, where pregnant women do not go to hospitals, except in obviously life-threatening situations. Most of these deaths could be prevented in a hospital, as they stem from hemorrhage, sepsis, and obstructed labor.

You can really say all you want about the "bondage of women" and "taking the dignity of childbirth" but then I would tell you that I don't give a shit about the symbolism or semantics. Speaking as a woman, I just don't. Childbirth is not about making a statement. It's about having a baby.

The whole point is having a baby that is alive and healthy, and if involving a supposed reinforcing of a"patriarchal world" increases the chances of that the smallest bit, then bring it on. Despite what you may think, childbirth is not about the mother. It was never about the mother. It's about the baby. The mother might have a problem-free childbirth, but babies often have problems that a midwife is not equipped to handle. What would she do if it stopped breathing? If it had a weak heart? Needed emergency surgery?

A friend of mine was born with a heart defect, another friend needed a spinal tap.

It's relatively easy to tell if a woman will have complications during childbirth, but babies are unpredictable.

My mother had three Cesarean sections, because it was physically impossible to give birth to a normal sized (8.5 pound) baby with her bone structure. I'm going to need a c-section also; I just don't have childbearing hips, and I'm going to have to deal with that. It's just the way things work. My genes are really nice too-- it would be a shame not to pass them on.

I agree that low-risk mothers should be perfectly safe and healthy giving birth at home attended by a midwife. I don't care about the pain. I would go through any amount of pain if it meant a healthier child. But again, it's not about the mother. I'm not saying that the child ismore important than the mother, or vice versa. All I'm saying is that I, personally, value the sanctity of human life over some vacuous rhetoric about supposed women's dignity. Don't be selfish. Go to a hospital.

If it saves the life of just one child, it's worth it.

As a woman and a feminist but first an individualist above all, I prefer not to express my freedom and liberation through my vagina. I believe that this attitude can only be detrimental to the dignity of women.

Narzos: Infant mortality (defined as death within the first year of life) for the US in 1998 was 7.2 in 1000. Two of a hundred is ridiculously high, which would make home births seem very dangerous. Check your statistics.
Thank you Cosmic Cat. You are so correct. Childbirth and pregnancy have been way over medicalized. You covered this aspect well in your W/U above. I want to add that childbearing women must themselves take back the responsibility as well their own power.

Take childbirth classes that teach non-pharmaceutical pain management. If you get an epidural a cascade of events begins that often leads to more and more medical interventions. This often leads to the flat on the back labors, limitations on walking, C-sections, and medicated babies who can't breastfeed effectively. Mothers with epidurals often get fevers leading to septic workups of their infants. This means multiple blood samples and a lumbar puncture for the newborn baby in many cases.

These classes won't be located within the hospital. Look elsewhere. Do your research. Nurses teaching within the hospital setting are often restricted in exactly what they can say. Anesthesiologists rarely admit that the medications they administer to the mother also affect the baby in negative ways. Money, god complexes, AND a sincere desire to stop pain all contribute to this.

Choose your healthcare providers carefully. Think about using a midwife. They have better track records than OBs in terms of safe births for mother and baby in low risk pregnancies. Make sure to research them too. See that my generalization is applicable to your specific case. Look for how they refer if risk factors are identified. Look for how they handle emergencies in terms of relationships with hospitals, doctors and ambulances. Look at their experience and their track record.

Choose the setting you wish to give birth in. Hospitals are not the only option. You can give birth in a birthing center staffed with midwives or at home. These are safe options! Statistically midwives have better outcomes in terms of the infant than OBs in low risk cases. They know how to assess the risk before the birth. They do not take on cases where C-sections will be needed. These things can be assessed ahead of time, as evidenced by Jennifer above KNOWING she will need one. Most women do not, and they don't need a hospital to have a birth that is safe for the baby. Interventions have a cost TO THE BABY.

Childbirth is a wonderful and empowering experience. Yes; it is hard but it can be managed. We are strong; we were designed for this work. Take back your power. Be glad that interventions are there when needed but don't be convinced that you need them without good evidence.

Coffy, When I speak of power, I am not talking about power OVER the pregnancy or the fetus, I am speaking of the power to be strong, to do the tremendous work of delivering a baby without interference IN NORMAL CIRCUMSTANCES. This results in a healthier mother AND a healthier baby. Of course I believe in prenatal care; it results in healthier babies and mothers even in low risk pregnancies and CLEARLY points out which pregnancies are high risk and in need of selected medical interventions. That is not the medicalization I am leery of.

Of course I believe in incubators for 2 pound babies (or any others who need them). Premature birth certainly calls for medical intervention. That is not the medicalization I am leery of.

The most important thing to be gleaned from this node is that medical interventions have a cost/benefit ratio. Acknowledge the cost as well the benefit. I am talking about developing a little fire in the gut and doing the right thing. I am talking about doing your homework and making informed decisions. I am talking about taking responsibility instead of allowing yourself to be patronized. The reason I seem to ranting on the less intervention side is I see so much intervention. 70% epidural rates and 25% Caesarean rates are common in many hospitals. Something is wrong with that.

By the way, in the US, nurse midwives are part of the "conventional medicine" scene. They can often admit and/or treat patients in hospitals. If they can't they have reciprocal relationships with MDs or ODs who can if complications occur during births they attend at home or in free standing birthing centers. "Lay" midwives are a different story and may not have such good back up.

Here is a place to start:
Read the section about giving birth in modern American hospitals

Much as I hate doing a response writeup, the argument that Jennifer presents here is fairly misleading. That's not really surprising, because most of the research on the safety of hospital births as opposed to home deliveries is fairly poorly publicized. In many ways, for a low risk pregnancy, a hospital delivery can actually be at least as dangerous, both for the baby and the mother, as a home birth attended by a competent midwife. This holds true in both the Third World and the First, though for fairly different reasons. Now, for high risk pregnancies, on the other hand, say breech deliveries or twins, hospital care is invaluable, and I think you'd be hard-pressed to find anybody to dispute that. The issue here is that what's good for a certain subset of women and babies is actually a poor choice for many others.

In America, the rate of babies who die in home deliveries attended by direct-entry midwives is about two out of every hundred (n.b. this is different from the infant mortality rate, which is calculated per live births; this figure includes stillbirths). This is exactly the same rate as in hospitals, and appears to be about as low as it can possibly go. The rate of epidurals at home deliveries: 0%, of course. The rate of mothers transported to hospitals for Caesarean Sections: about 5%, as opposed to normally 15%, and as high as 30 to 40 at some hospitals. Nobody knows what effect the anaesthetics used on mothers have on developing children, but we do know that they pass directly into the baby's bloodstream through the umbilicus.

It's true that the rate of infant mortality decreased drastically around 1900, which was also the time that doctors began handling childbirths. But, as we all know, correlation does not imply causality. Actually, the two single developments which are probably most responsible for this are better nutrition (which drastically lowers the rate of hemorrage and sepsis, more on this in a bit), and the advent of the germ theory of disease, which was adopted both by doctors and midwives, and led to regular hand-washing, and better sterility on the part of all.

Now, in the Third World, on the other hand, the rate of infant mortality remains very, very high. Somalia's a bit of a special case, seeing as it has no functioning government and relatively little contact with the outside world these days, but the statistics that Jennifer quoted are true, or close to true, for a number of other countries as well. Again, the single biggest culprit in this is malnutrition. When the mother's not properly nourished, she becomes exponentially more vulnerable to hemmorage, infection, and a variety of other conditions, and the health of her baby is endangered as well. Now, it's safe to say that transport to hospitals will have no effect on this malnutrition - it may even make the conditions worse, because many hospitals forbid women from eating during the labor period, and feed them sugar water through an IV instead.

One particular problem with hospitals in the third world is that sanitary conditions are often atrocious, and this drastically increases the risk of infection, both for the mother and the child. So much so that many NGOs and other foreign-aid groups are actually finding it more cost-effective and life-saving to provide basic medical training (on sanitation, and how to deliver CPR) to local traditional midwives, than to spend the money on more hospitals.

Home birth isn't the best answer for every mother, but neither is delivery in a hospital. There's a mounting body of evidence that for a fairly large population, home birth really is the best answer.

It seems to me that instead of arguing over statistics we might want to consider that childbirth is as much about the mother as it is the fetus. This is because they are not separate entities.

The Western philosophical tradition, with its emphasis on discrete, rational individuals as "units of existence" fails to take into account that the fetus is not some tiny adult living in a uterine "house." Its very existence is symbiotic. So it's senseless to bicker about whose welfare is more important--mother or child-to-be.

Forgive the aside. I would also like to point out that high-risk pregnancies cannot always be evaluated in advance. I owe my life and most of my mental faculties to medical technology. I was breech, 2 months premature, and had the umbilical cord wrapped around my neck when I was delivered in intensive care. I weighed 2 pounds and 3 ounces. Without the advent of the incubator I never would have survived. I firmly believe that if my mother had not had regular sonograms, she would never have known I was in danger. She took impeccable care of herself throughout her pregnancy and had already given birth to one healthy child.

The most important thing to be gleaned from this node is not that doctors are in the business of usurping women's "power" over their pregnancies. Rather, it is that conventional medicine should be applied in a way that does not dehumanize the pregnant woman. If the woman does choose to have her baby by means of a midwife, this doesn't mean that she should ignore the life-saving benefits that conventional medicine has to offer.

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