The Medicalization of Childbirth

Yeah, I know, I’m talking about medicalization again. Seriously though, it’s a process that influences so many aspects of our society and I dislike it so much! That all being said, I promise this is my last medicalization post for a little while so bear with me.

So what do I mean by “the medicalization of childbirth”? I would define it as the process in which the phenomenon of childbirth is seen as something that requires medical interventions in order to be successful. The female body alone is not seen as sufficient and, without these medical interventions, not only would the birthing process be unsuccessful, it would also be dangerous. This medicalization process did not happen overnight. According to Kristi Williams and Debra Umberson in their article, “Medical Technology and Childbirth: Experiences of Expectant Mothers and Fathers,” before the nineteenth century, “childbirth was treated largely as a natural process requiring little or no medical intervention. In the mid- to late-1800s, however, a number of social and cultural factors converged to open the door for medical involvement in the birth process…A central component of this effort was the medicalization of pregnancy and childbirth and the elimination of the competition of midwives” (149). The medicalization of childbirth was born out of competition and a need to make money. The Industrial Revolution also began at around this time and its themes seeped from the factory floor into the birthing room. The body, namely the female body, came to be seen as a machine that can break down and the doctor came to be seen as the mechanic. The doctor becomes the only person who can fix the flaws inherent in the female body. As a result, “the woman becomes the recipient rather than the producer of the child” (149-150). She loses her reproductive power as she is reduced to a potentially dangerous vessel from which the doctor must procure the child.

These themes are still present today. How many times have you heard a woman mention receiving and/or desperately needing epidurals or other forms of pain medication the moment someone brings up the topic of childbirth? And in this country, most births take place in a hospital under the guidance of doctors and nurses. But hospitals are places for the sick. Why should a perfectly healthy pregnant woman automatically be expected to have her baby in a hospital? Because women are made to be afraid. Women are scared of a process that they (and other mammals) have been doing for ages. As Kiki Zeldes and Judy Norsigian declare in their article, “Encouraging Women to Consider a Less Medicalized Approach to Childbirth Without Turning Them Off: Challenges to Producing Our Bodies, Ourselves: Pregnancy and Birth,” “Highly medicalized birth is now the norm for most women, and the perception is that they should fear birth—or at least worry about it incessantly. Many women believe labor and birth will involve insurmountable pain and suffering that can be controlled only with an epidural, and that a medicalized, high-tech birth is the best and safest option for them and their babies” (246). When you hear women talk about giving birth, all they can talk about is how painful and horrible it will be/was and how they will demand medication the moment they set foot in the hospital. You really can’t blame women too much when all their information about childbirth is gained from the medical system and the media. Have you ever seen a TV show or a movie that did not depict childbirth as a horrible apocalyptic event? I haven’t. Women are being primed from the start to have certain beliefs about childbirth. It seems as if giving birth is this horrible life or death situation that one can barely survive, which is interesting when one realizes that women and animals have been able to continue their species for all this time. How were women in the past able to bear it if it was so terrible? And don’t animals feel this pain too? If giving birth was so terrible, why haven’t mammals evolved to make this process completely painless? You would think (if we are analyzing this from an evolutionary standpoint) that since this horrible process could potentially affect the reproductive success of numerous species, a mechanism would have evolved to ease this process. But it hasn’t. Animals are usually able to bear it just fine. What makes humans so different? Are we weaker than animals?

Apparently, we are if all these medical interventions are anything to go by. The medical interventions I will be discussing in this post are elective inductions and caesarian sections (aka c-sections). 

• Inductions are measures taken to speed up the birth of a child. Inductions are appropriate if the continuation of the labor would negatively affect the health of the mother or the child. Inductions become ‘elective inductions’ when the labor is sped up for reasons other than the health of the mother or child. In a labor without complications and a healthy mother, there is no need whatsoever for inductions. And inductions in low-risk pregnancies come with risks. In the article, “Elective Induction of Labor as a Risk Factor for Cesarean Delivery Among Low-Risk Women at Term,” Arthur S. Maslow and Amy L. Sweeny discuss some of the risks and costs of having an induced vaginal birth. They reveal that inducing labor in an otherwise healthy pregnancy “significantly increased the risk of cesarean delivery for nulliparas [women who have never given birth before], and increased hospital predelivery time and costs” (917). Complications that arise from interventions can result in more interventions, which could result in more complications. This cascade effect could then put the mother and/or child at risk, necessitating an emergency c-section that was previously unneeded. Maslow et al. brings up another point: Not only are electively induced vaginal births correlated with an increased risk for an unplanned c-section, they also cost more money than a non-induced birth. Maslow et al. calculated the cost to be an “additional $273 per elective induction” (921). With an additional predelivery time of four hours (an extra four hours before the baby is actually born), the actual induction procedure and an increased chance of epidural use (probably due to the extra four hours of labor), it is not hard to see why an induced birth would cost more money (917, 921).
• Cesarean sections, also known as c-sections, are becoming a disturbing trend in childbirth in this country. Silver et al. discloses this alarming fact in their article,  “Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries:” In 2006, the c-section rate in the US reached over 29%. Much higher than the World Health Organization’s maximum recommended rate of 15% (1231). Although the Maternity Center Association in New York has declared that vaginal births are safer than c-sections, the American College of Obstetricians and Gynecologists “has determined that it is ethically permissible to accede to a request for an elective cesarean section from an informed woman (Klein 161). However, are women being properly informed? They are already being primed to believe that non-induced vaginal births are one of the most dangerous and/or painful events they can possibly experience. On top of that, many doctors in this country tend to tout c-sections as a much safer and much more convenient alternative. But is that really the case? Zeldes et al. do not think so. They disagree saying, “Most women are not aware that the pain of a cesarean birth may extend well beyond the postpartum period. A recent Birth article on postpartum problems showed that 18 percent of women who had a cesarean section reported pain at the site of the incision 6 months after surgery” (247). A cesarean section is a surgery with all of the risks and complications that come with it. The hospital stay is extended in order for the mother to recover from the surgery and Silver et al, lists other risks and complications that one has to think about before undergoing a c-section: “Serious maternal morbidity [illness] increases with increasing number of cesarean deliveries. The majority of this risk is attributable to that associated with placenta accreta [when the placenta attaches too deeply to the uterus] and/or the need for hysterectomy [removal of the uterus]. Placenta postoperative ventilation, intensive care unit admission, operative time, and days of hospitalization, also was increased with increasing number of cesarean deliveries”(1229-1230). All of these risks are not considered when perfectly healthy women decide to go under the knife.

 So as a result of a lack of knowledge and fear of pain, women allow these unnecessary medical interventions to occur, putting themselves at potential physical risk. However, a woman’s physical health is not the only thing that suffers. Williams et al. declare, “research on women’ s pregnancy and childbirth experiences suggests that the use of medical technology alienates many women by minimizing the importance of their roles and their level of control over their bodies and birth experiences” (147). Apparently, medical interventions have a tendency to decrease a woman’s birthing self-efficacy, meaning they negatively affect a woman’s belief that she is strong enough to give birth on her own.  N.K. Lowe further examines the birthing self-efficacy of pregnant women in their article, “Self-efficacy for labor and childbirth fears in nulliparous pregnant women”. Lowe states, “If a woman does not believe that she is capable of the tasks or effort required to cope with labor, she is unlikely to be motivated even to try. Avoidance of, or withdrawal from, the experience through anesthesial analgesia or even Cesarean section becomes an attractive alternative. Likewise, her thoughts about labor, including her affective state, are influenced so that labor becomes an insurmountable task generating great anxiety and fear” (223). Women are then encouraged to give up their control to medical “experts” and to medical interventions that are unneeded and potentially dangerous.

There is another school of thought, unrelated to fear and the “dangers” of vaginal birth, that support full elective medical interventions during childbirth: convenience. William F. Rayburn and Jun Zhang discuss the appeal of convenience in their article, “Rising Rates of Labor Induction: Present Concerns and Future Strategies”. They admit: “Scheduling an induction rather than waiting for spontaneous labor offers many advantages: easing domestic arrangements, ensuring attendance of the patient’s physician, and avoiding journeys during labor either from distant places or in severe climatic conditions” (166). Planning the birth of one’s child the same way one would plan a business meeting does seem appealing. And many women see it as exercising their right to choose and the ability to medically control the frightening birthing process. Being able to plan one’s labor also sounds like a dream to doctors. They could schedule deliveries to the days and times that are the most convenient for them. Also, according to Klein, elective c-sections and other medical interventions are supported by many in the medical community because the interventions make the birthing process something they can totally control (163). This is true for c-sections, especially. Instead of relying on the workings of a woman’s body and giving it the time and/or space needed for it to do what it has evolved to do, doctors can just perform the surgery, deliver the baby and move on with their day.

Despite the conveniences, as stated previously, there are a lot of health risks associated with elective c-sections and inductions that women are not being made aware of. Klein bemoans the fact that “women rarely receive the time (which should be at least an hour) that a full discussion of the complexities of birth alternatives deserves. Moreover, the person providing the counseling is often in a conflict of interest” (162-163). Women are not being properly informed of all the possible risks of medical interventions in part because these interventions tend to be more convenient for the doctor. The issue of choice and consent in regards to elective medical interventions is a gray one because how can someone make an informed decision without accurate information? Women are made to believe that vaginal births are terrifying and that c-sections, epidurals and inductions are the safest ways to give birth when that is not necessarily the case. Instead women should be made aware of the power and magnificence of their bodies. They should be aware that it is possible to give birth without heaps of medication and they do not need medical interventions in low-risk pregnancies. If after receiving accurate and detailed information, a woman still wants some medical intervention than that is her decision, but without being properly informed, it seems as if women are being trapped into believing that their bodies are once again not good enough.