Medicalization Of Pregnancy Sociology Essay
From the initial pronouncement by the GP that a woman is pregnant to the regular scans and antenatal process pregnant women are expected to participate in, pregnancy has been redefined as a potential risky process requiring medical surveillance. Explain this statement using sociological concepts including medicalization and consider the advantages and disadvantages of this approach to pregnancy.
The medicalization of pregnancy and childbirth has changed from something that was previously the most natural process into an extremely risky process, so why is this and what does the term medicalization actually mean when applied to the pregnancy process? This following assignment will discuss the definition of medicalization, medical social …show more content…
control and how it applies to the risk of pregnancy and childbirth. It will explore the history of pregnancy procedures and discuss the current processes of pregnancy from the initial pronouncement to the expectations of the pregnant woman throughout the pregnancy term. The assignment will also discuss the sociological concepts and theories, including the advantages and disadvantages of the medicalization of pregnancy.
There are many definitions of medicalization but according to Conrad (1992) “medicalization describes a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders” – pregnancy and childbirth is a prime example of this definition. Along with medicalization came medical social control and Conrad (1979) states there are four main types of medical social control, these are: medical ideology, medical collaboration, medical technology and medical surveillance. Whilst the risks of pregnancy and childbirth may fall under all four of these types of social control, the main control would be medical surveillance along with medical technology.(Conrad: 1992)
The most important change within pregnancy and childbirth is the transition from the private sphere (giving birth at home) to the public sphere of the hospital. (Symonds & Hunt: 1996) Initially, midwives were un-qualified women whose experience was based purely on their own childbirth and what they had learned from other women. Perceptions of midwives varied from being old, drunken, unclean women to conscientious, clean kept and caring women. (Kent: 2000) Depending on wealth, women in the nineteenth century would encounter different types of midwives. For those that were poor, lay midwives or handywomen would be present at the birth however, often these classes of women would receive their treatment in hospitals where there was no charge for treatment but meant obstetricians were free to carry out treatments or operations enabling them to develop their own skills and knowledge (Kent: 2000) Middle class women would receive more expensive medical care (Kent: 2000)
According to Leap and Hunter (1993) during the late nineteenth century a group of women set up a campaign to enable the training and practice of midwives which led to the 1902 Midwives Act. Prior to the introduction of this Act, eight attempts to upgrade the role of midwife had failed. The introduction of the act meant that it was illegal for any untrained person to attend a birth other than if instructed by a doctor and it was a statutory responsibility for a midwife to attend. (Kent: 2000) Hospital births began to increase prior to the Second World War and the introduction of the National Health Service in 1946 saw a massive increase in maternity beds which was free to all. (Kent: 2000) Feminist’s theory of the medicalization of childbirth defined the process as an’ expression of patriarchal power’ and feminists such as Donnison and Oakley would argue that this meant that women were now subjected to male power. Oakley in particular sees the move of childbirth into a male area as robbing women of autonomy and losing control of their own bodies (Symonds & Hunt: 1996)
As documented by Hunt in 2005, Ivan Illych critiqued that pregnancy, which was once such a natural process was now ruled by the male profession. Medicalization of this process was apparent due to the mass increase in hospital births. In 1927 only fifteen per cent of births took place in hospital where in 1980 an astonishing ninety eight per cent of births were hospitalised. (Hunt: 2005)
Nowadays, pregnant women have very little say throughout their pregnancy and focus on the foetus has become more important than the actual mother who loses her own identity whilst carrying the unborn child. Women are expected to conform to the guidelines set by Doctors with regards to factors such as diet: what we can or cannot eat, exercise, alcohol consumption and smoking. These factors create or identify categories such as: good mother (for those who follow guidelines) and bad mother (for those who choose to ignore said guidelines) and in which society is only too quick to judge. From the first confirmation by the General Practitioner that the woman is pregnant, she is immediately put under ‘surveillance’ for the remainder of her pregnancy period. The pregnant woman must attend regular scans and routine appointments with both her midwife and also with obstetricians whilst monitoring her behaviour. She is also likely to undergo physical examinations and possibly genetic tests, will have blood tests and receive visits from a Health Visitor. So for example: the woman’s diet, if the woman has a higher than normal Body Mass Index, she may well be referred to an obstetrician who specialises in that area of practice. The more intervention involved the more likelihood that some form of intervention is needed throughout pregnancy and labour however what we must question is: is this amount of surveillance or interference at all beneficial or even necessary.
Risks can occur during every pregnancy and there are many factors that contribute to the risks such as: age, weight or previous pregnancies. Risks during pregnancy can often be magnified if the woman already suffers from chronic conditions such as high blood pressure, heart disease, diabetes or kidney problems which would require additional pre-natal care. (Medline plus: 2013) Pre-natal care is monitored very closely with routine check-ups to the midwife occurring approximately once a month at the start of the pregnancy. The closer the birth date approaches, the closer the visits to the midwife. The midwife will give advice on physical activity and diet to try and make the pregnancy as healthy as possible. She will also perform many checks throughout this period such as checking bloods (for lack of iron) or to check the woman’s blood type as depending on the type of blood, further intervention may be needed, checking of blood pressure and weight and also measuring the size of the baby (again depending on size of baby further intervention such as growth scans be may needed if baby is measuring too big or too small to the ‘norm’. All of these factors can contribute to the risky process of pregnancy and birth. (Medline plus: 2013)
There is a huge on-going debate as to whether or not hospital births are more beneficial than home births. Whilst there are many advantages towards the medicalization of pregnancy that suggests it is such as: knowing that you are in the safest place in case of any emergencies during labour especially if the pregnancy is classed as ‘higher risk’ can make the woman feel at ease. Depending on the hospital and area (for example large teaching hospitals) will have up to date medical equipment and most likely have a Doctor on-call at all times (Milk & Mud: 2013) Hospitals will provide very high levels of support for the new born child i.e: neo-natal units and specialised care units, increased availability of pain relief and medication (whereas this may be limited in the home environment) (Milk & Mud: 2013) However, for all the advantages there are just as many disadvantages that suggest hospital births are not necessarily in the best interest of the patient. Hospitals are governed by rules and therefore expect their patients to conform to these rules. (Milk & Mud: 2013) Most, if not, all hospital births will experience some sort of intervention. Every hospital has their own guidelines or policies as to how long a ‘healthy’ labour should last therefore women in labour may be encouraged to speed up their delivery with the intervention of drugs (Babycentre: 2013) Forms of intervention may also take place if the labour is not going to plan or according to ‘text book’ standards. Whilst in hospital, women will be more at risk of infections such as MRSA and may find themselves subject to un-necessary routine and procedures even if their pregnancy is classed as low risk. They will have less privacy than if giving birth at home and will not receive the personal one-to-one care as would be applied at home, this may be due to staff shortages or change-over of shifts (Milk & Mud: 2013)
We can see by figures produced just how much the shift from home to hospital births have increased.
In the beginning of the 1900’s, almost ninety nine per cent of births took place in the home however by the 1950’s, only approximately thirty per cent now took place in the home. (NCT: 2008) So why is this? National Childbirth Trust, a charity founded in 1956, was initially set up to promote and understand the system of natural childbirth. The charity would argue that home births are perfectly safe for healthy women situated in the ‘low risk’ category and that there is no evidence to suggest otherwise (NCT; 2012) The charity’s policy has eleven factors, the first being that ‘all parents should be able to choose a place to give birth that they feel is right for them and their baby’. They also believe that parents need up to date evidence to enable them to make a suitable decision for their place of birth. (NCT: 2008) In 1970 the Peel Report was published. The report gave a negative perception on home births giving the impression that home births were less advanced than hospital births but there was no evidence to back this up. The report was challenged due to lack of evidence and twenty two years later, was proven to be incorrect. (NCT: 2008) It was the Government’s Policy to increase women’s choices of places of birth and that from 2009, home births would be guaranteed (NCT: 2008) However, we know that this is not necessarily the case and that home births can very much depend on circumstances and resources i.e., location, midwife availability and medical attention required to name a few . (NCT: 2008) It is evident by looking at documentation produced by interest groups such as The National Childbirth Trust that pregnant women may not have as much choice in the place of their child’s birth as is lead to believe by the Government and that more information needs to be distributed effectively to enable this to
happen.
While it is lead to believe that pregnant women now have more choice throughout this period, are we mislead by what we believe is choice when in fact we are still being controlled ? Despite Government policies, GP’s tend to have the final say in where a birth should take place and although the NHS produces care pathways, they are aimed in general rather than on an individual basis (Kirkham: 2004) Whilst women may be able to express their choices, very few are endorsed: technology rules and a ‘doctor knows best’ attitude is often portrayed to them. (Kirkham: 2004)
There are various life events that we all encounter however there is no life event that is exclusively linked to one sex only - other than pregnancy and childbirth, these events ‘belong’ to women. (Symonds & Hunt: 1996) Evidence suggests that whilst some medical surveillance is vital during pregnancy, the more testing and surveillance that is carried out can contribute to the increase in fears and anxieties amongst pregnant women as everyone’s perceptions differ to that of the next person. This assignment has discussed the history of pregnancy procedures and how it has changed compared to today’s procedures and expectations of the pregnant woman. It has discussed the advantages and disadvantages of the medicalization of pregnancy and discussed why such a natural process is now perceived as a risky process.
Bibliography
Babycentre, LLc ( 2013) Giving birth in hospital, available [online] at : http://babycentre.co.uk/a1046223/giving-birth-in-hospital (accessed: 13/2/2013)
Cahill, H (2000) Male appropriation and medicalization of childbirth: an historical analysis
Conrad, P (1992) Medicalization and social control, Annual Review of Sociology, vol. 18, pp.209-232
Gelis, J (1991) History of childbirth, Polity Press: Cambridge
Hunt, S (2005) The life course: a sociological introduction, Palgrave Macmillan: Hampshire
Hunt, S & Symonds, A (1995) The social meaning of midwifery, Macmillan Press Ltd: London
Kent, J (2000) Social perspectives on pregnancy and childbirth for midwives, nurses and the caring professions, Open University Press: Berkshire
Kirkham, M (ed) (2004) Informed choice in maternity, Palgrave Macmillan: Hampshire
Medline Plus (2013) Prenatal Care available [online] at http://www.nlm.nih.gov/medlineplus/prenatalcare.html (accessed 16/2/2013)
Milk and Mud, LLC, (2013) Hospital Birth Available [online] at http://www.naturalbirthandbabycare.com/hospital-birth.html (accessed 13/2/2013)
National Childbirth Trust (2012) NCT: the UK’s largest charity for patients, available [online] at http://www.nct.org.uk/about-nct/our-history (accessed: 16/2/2013)
National Childbirth Trust (2008) NCT Briefing: Home Birth,
Oakley, A (1992) Social support and motherhood: the natural history of a research project, Blackwell Publishers: Oxford
Oakley, A (1993) Essays on women, medicine and health, Edinburgh University Press: Edinburgh
Symonds, A & Hunt, S (1996) The midwife and society: perspectives, policies and practice, Macmillan Press Ltd: London.
The medicalization of pregnancy and childbirth has changed from something that was previously the most natural process into an extremely risky process, so why is this and what does the term medicalization actually mean when applied to the pregnancy process? This following assignment will discuss the definition of medicalization, medical social …show more content…
control and how it applies to the risk of pregnancy and childbirth. It will explore the history of pregnancy procedures and discuss the current processes of pregnancy from the initial pronouncement to the expectations of the pregnant woman throughout the pregnancy term. The assignment will also discuss the sociological concepts and theories, including the advantages and disadvantages of the medicalization of pregnancy.
There are many definitions of medicalization but according to Conrad (1992) “medicalization describes a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders” – pregnancy and childbirth is a prime example of this definition. Along with medicalization came medical social control and Conrad (1979) states there are four main types of medical social control, these are: medical ideology, medical collaboration, medical technology and medical surveillance. Whilst the risks of pregnancy and childbirth may fall under all four of these types of social control, the main control would be medical surveillance along with medical technology.(Conrad: 1992)
The most important change within pregnancy and childbirth is the transition from the private sphere (giving birth at home) to the public sphere of the hospital. (Symonds & Hunt: 1996) Initially, midwives were un-qualified women whose experience was based purely on their own childbirth and what they had learned from other women. Perceptions of midwives varied from being old, drunken, unclean women to conscientious, clean kept and caring women. (Kent: 2000) Depending on wealth, women in the nineteenth century would encounter different types of midwives. For those that were poor, lay midwives or handywomen would be present at the birth however, often these classes of women would receive their treatment in hospitals where there was no charge for treatment but meant obstetricians were free to carry out treatments or operations enabling them to develop their own skills and knowledge (Kent: 2000) Middle class women would receive more expensive medical care (Kent: 2000)
According to Leap and Hunter (1993) during the late nineteenth century a group of women set up a campaign to enable the training and practice of midwives which led to the 1902 Midwives Act. Prior to the introduction of this Act, eight attempts to upgrade the role of midwife had failed. The introduction of the act meant that it was illegal for any untrained person to attend a birth other than if instructed by a doctor and it was a statutory responsibility for a midwife to attend. (Kent: 2000) Hospital births began to increase prior to the Second World War and the introduction of the National Health Service in 1946 saw a massive increase in maternity beds which was free to all. (Kent: 2000) Feminist’s theory of the medicalization of childbirth defined the process as an’ expression of patriarchal power’ and feminists such as Donnison and Oakley would argue that this meant that women were now subjected to male power. Oakley in particular sees the move of childbirth into a male area as robbing women of autonomy and losing control of their own bodies (Symonds & Hunt: 1996)
As documented by Hunt in 2005, Ivan Illych critiqued that pregnancy, which was once such a natural process was now ruled by the male profession. Medicalization of this process was apparent due to the mass increase in hospital births. In 1927 only fifteen per cent of births took place in hospital where in 1980 an astonishing ninety eight per cent of births were hospitalised. (Hunt: 2005)
Nowadays, pregnant women have very little say throughout their pregnancy and focus on the foetus has become more important than the actual mother who loses her own identity whilst carrying the unborn child. Women are expected to conform to the guidelines set by Doctors with regards to factors such as diet: what we can or cannot eat, exercise, alcohol consumption and smoking. These factors create or identify categories such as: good mother (for those who follow guidelines) and bad mother (for those who choose to ignore said guidelines) and in which society is only too quick to judge. From the first confirmation by the General Practitioner that the woman is pregnant, she is immediately put under ‘surveillance’ for the remainder of her pregnancy period. The pregnant woman must attend regular scans and routine appointments with both her midwife and also with obstetricians whilst monitoring her behaviour. She is also likely to undergo physical examinations and possibly genetic tests, will have blood tests and receive visits from a Health Visitor. So for example: the woman’s diet, if the woman has a higher than normal Body Mass Index, she may well be referred to an obstetrician who specialises in that area of practice. The more intervention involved the more likelihood that some form of intervention is needed throughout pregnancy and labour however what we must question is: is this amount of surveillance or interference at all beneficial or even necessary.
Risks can occur during every pregnancy and there are many factors that contribute to the risks such as: age, weight or previous pregnancies. Risks during pregnancy can often be magnified if the woman already suffers from chronic conditions such as high blood pressure, heart disease, diabetes or kidney problems which would require additional pre-natal care. (Medline plus: 2013) Pre-natal care is monitored very closely with routine check-ups to the midwife occurring approximately once a month at the start of the pregnancy. The closer the birth date approaches, the closer the visits to the midwife. The midwife will give advice on physical activity and diet to try and make the pregnancy as healthy as possible. She will also perform many checks throughout this period such as checking bloods (for lack of iron) or to check the woman’s blood type as depending on the type of blood, further intervention may be needed, checking of blood pressure and weight and also measuring the size of the baby (again depending on size of baby further intervention such as growth scans be may needed if baby is measuring too big or too small to the ‘norm’. All of these factors can contribute to the risky process of pregnancy and birth. (Medline plus: 2013)
There is a huge on-going debate as to whether or not hospital births are more beneficial than home births. Whilst there are many advantages towards the medicalization of pregnancy that suggests it is such as: knowing that you are in the safest place in case of any emergencies during labour especially if the pregnancy is classed as ‘higher risk’ can make the woman feel at ease. Depending on the hospital and area (for example large teaching hospitals) will have up to date medical equipment and most likely have a Doctor on-call at all times (Milk & Mud: 2013) Hospitals will provide very high levels of support for the new born child i.e: neo-natal units and specialised care units, increased availability of pain relief and medication (whereas this may be limited in the home environment) (Milk & Mud: 2013) However, for all the advantages there are just as many disadvantages that suggest hospital births are not necessarily in the best interest of the patient. Hospitals are governed by rules and therefore expect their patients to conform to these rules. (Milk & Mud: 2013) Most, if not, all hospital births will experience some sort of intervention. Every hospital has their own guidelines or policies as to how long a ‘healthy’ labour should last therefore women in labour may be encouraged to speed up their delivery with the intervention of drugs (Babycentre: 2013) Forms of intervention may also take place if the labour is not going to plan or according to ‘text book’ standards. Whilst in hospital, women will be more at risk of infections such as MRSA and may find themselves subject to un-necessary routine and procedures even if their pregnancy is classed as low risk. They will have less privacy than if giving birth at home and will not receive the personal one-to-one care as would be applied at home, this may be due to staff shortages or change-over of shifts (Milk & Mud: 2013)
We can see by figures produced just how much the shift from home to hospital births have increased.
In the beginning of the 1900’s, almost ninety nine per cent of births took place in the home however by the 1950’s, only approximately thirty per cent now took place in the home. (NCT: 2008) So why is this? National Childbirth Trust, a charity founded in 1956, was initially set up to promote and understand the system of natural childbirth. The charity would argue that home births are perfectly safe for healthy women situated in the ‘low risk’ category and that there is no evidence to suggest otherwise (NCT; 2012) The charity’s policy has eleven factors, the first being that ‘all parents should be able to choose a place to give birth that they feel is right for them and their baby’. They also believe that parents need up to date evidence to enable them to make a suitable decision for their place of birth. (NCT: 2008) In 1970 the Peel Report was published. The report gave a negative perception on home births giving the impression that home births were less advanced than hospital births but there was no evidence to back this up. The report was challenged due to lack of evidence and twenty two years later, was proven to be incorrect. (NCT: 2008) It was the Government’s Policy to increase women’s choices of places of birth and that from 2009, home births would be guaranteed (NCT: 2008) However, we know that this is not necessarily the case and that home births can very much depend on circumstances and resources i.e., location, midwife availability and medical attention required to name a few . (NCT: 2008) It is evident by looking at documentation produced by interest groups such as The National Childbirth Trust that pregnant women may not have as much choice in the place of their child’s birth as is lead to believe by the Government and that more information needs to be distributed effectively to enable this to
happen.
While it is lead to believe that pregnant women now have more choice throughout this period, are we mislead by what we believe is choice when in fact we are still being controlled ? Despite Government policies, GP’s tend to have the final say in where a birth should take place and although the NHS produces care pathways, they are aimed in general rather than on an individual basis (Kirkham: 2004) Whilst women may be able to express their choices, very few are endorsed: technology rules and a ‘doctor knows best’ attitude is often portrayed to them. (Kirkham: 2004)
There are various life events that we all encounter however there is no life event that is exclusively linked to one sex only - other than pregnancy and childbirth, these events ‘belong’ to women. (Symonds & Hunt: 1996) Evidence suggests that whilst some medical surveillance is vital during pregnancy, the more testing and surveillance that is carried out can contribute to the increase in fears and anxieties amongst pregnant women as everyone’s perceptions differ to that of the next person. This assignment has discussed the history of pregnancy procedures and how it has changed compared to today’s procedures and expectations of the pregnant woman. It has discussed the advantages and disadvantages of the medicalization of pregnancy and discussed why such a natural process is now perceived as a risky process.
Bibliography
Babycentre, LLc ( 2013) Giving birth in hospital, available [online] at : http://babycentre.co.uk/a1046223/giving-birth-in-hospital (accessed: 13/2/2013)
Cahill, H (2000) Male appropriation and medicalization of childbirth: an historical analysis
Conrad, P (1992) Medicalization and social control, Annual Review of Sociology, vol. 18, pp.209-232
Gelis, J (1991) History of childbirth, Polity Press: Cambridge
Hunt, S (2005) The life course: a sociological introduction, Palgrave Macmillan: Hampshire
Hunt, S & Symonds, A (1995) The social meaning of midwifery, Macmillan Press Ltd: London
Kent, J (2000) Social perspectives on pregnancy and childbirth for midwives, nurses and the caring professions, Open University Press: Berkshire
Kirkham, M (ed) (2004) Informed choice in maternity, Palgrave Macmillan: Hampshire
Medline Plus (2013) Prenatal Care available [online] at http://www.nlm.nih.gov/medlineplus/prenatalcare.html (accessed 16/2/2013)
Milk and Mud, LLC, (2013) Hospital Birth Available [online] at http://www.naturalbirthandbabycare.com/hospital-birth.html (accessed 13/2/2013)
National Childbirth Trust (2012) NCT: the UK’s largest charity for patients, available [online] at http://www.nct.org.uk/about-nct/our-history (accessed: 16/2/2013)
National Childbirth Trust (2008) NCT Briefing: Home Birth,
Oakley, A (1992) Social support and motherhood: the natural history of a research project, Blackwell Publishers: Oxford
Oakley, A (1993) Essays on women, medicine and health, Edinburgh University Press: Edinburgh
Symonds, A & Hunt, S (1996) The midwife and society: perspectives, policies and practice, Macmillan Press Ltd: London.