In the 1700s, Barber-surgeons, predecessors of the obstetricians belonged to a low social standing, similar to that of carpenters and shoemakers, members of the arts and trade guild. In an attempt to create social mobility and improve social status, barber-surgeons saw the opportunity to expand their expertise and redefined the perception of their skill as life saving, a higher moral order. Soon, barber-surgeons gained a competitive edge over midwives to practise at difficult home-deliveries, through manual non-medical-instrumental extraction of fetus from the birthing woman (Dundes, 1987). Contrary to lay belief that fetal life began only at the point of “quickening” when expectant woman felt fetal movement (20 weeks), Obstetricians utilized their bio-scientific knowledge from the expertise of the microscope to claim that the start of perinatal life begins from the point of conception (Costello, 2006). This Interprofessional rivalry sparked resistance from the displaced midwives. However, English midwives succeeded in certifying midwifery practice through the 1902 Midwifery act (Costello, 2006). This was an important step in establishing midwives not as physician-rivals, but as para-medical subordinates. In the same year, 1902, the Journal of Obstetrics and Gynecology of the British Empire was published (Drife, 2002). Early physician Mosher observed inverse relationship of declining birthrate and increasing abortion rate. He hypothesized that women opted for “criminal abortion” to avoid childbirth pain. This sparked widespread attention from society to reduce the disincentives of childbirth. Hence, obstetricians made claims to be able to alleviate childbirth pain, creating a market for obstetrics. In 1900s, only 15% of deliveries were in hospitals (Jones, 1994), after the ministry of health expanded maternal hospital facilities, hospital deliveries sored from 60% in 1925, to 70% in 1935 and 98% in 1950 (Loudon, 1988). This sharp increase also correlates with the emergence of chloroform and ether as the first analgesics during the mid 1800s, followed by the Twilight Sleep consumer movement, of scopolamine and morphine, in the early 1900s, championed by middle and upper class women for fundamental rights to painless childbirth. Under the guise of these feminist efforts, medicalization of pregnancy and childbirth changed the orientation of childbirth to something unnatural, and created consumer demand for medical intervention. Finally, the formation of universal healthcare systems, such as the NHS, in an attempt to provide welfare-state equality to healthcare access, gained power over women’s reproductive status and decisions.
Medicalization occurs when a social problem is “defined in medical terms, described using medical language, understood through the adoption of a medical framework, or ‘treated with medical interventions” (Conrad, 2007). Pregnancy and childbirth has been subjected to the process of medicalization through increased medical jurisdiction and medical surveillance over these natural domains of life.
There are three levels of medicalization: conceptual, institutional, and interactional (Conrad, 2007). This essay explores ways at which these three levels of medicalization have been applied to pregnancy and childbirth, and its consequences.
3.1 Conceptual medicalization
Pregnancy was an experience strictly confined to women, while childbirth was a domestic event attended by female relatives and midwives. This exclusive and empowering experience opposed and threatened patriarchy, the dominant culture of modern society, creating a social problem of female superiority. Hence, professional obstetricians emerged, eliminated midwifery, and created a medical model of practice that cast a disabling view on pregnancy and childbirth, allowing male participation as women’s salvation or at least, her equal. Medical authority and medical technologies attempt to reduce...
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