REPRODUCTIVE JUSTICE
MEDICALIZATION IN MATERNAL HEALTHCARE
**NOTE**
Medical advancements have saved the lives of women and babies at risk for
injury or death during pregnancy and birth.
This site is not about the doctors who properly use interventions to save
lives; it is about those who use them unethically for profit or convenience.
Improperly used interventions have led
to harm and death of women and babies and obstetrics
is the only field in which mortality
rates are rising and non-medically needed interventions such as c-sections are
related to 66% of maternal deaths.
**NOTE**
This site is designed to share valid evidence for those working to change
the maternal healthcare system who do not have access to databases of peered
research.
**NOTE**
Chronological order allows users to find new data.
It also begs the question of why, when we have known for decades that
such practices are harmful, do they not only continue to be used but are
increasingly used.
HISTORY OF MEDICALIZATION OF PREGNANCY AND BIRTH
WHAT DOES THE LITERATURE SAY?
2021
University of Houston Digital History (2021). Childbirth in Early America. Accessed https://www.digitalhistory.uh.edu/topic_display.cfm?tcid=70
In recent years, a reaction has occurred against the sterile impersonality of modern hospital delivery. Women today are much more likely than their mothers or grandmothers to want a "natural childbirth." Beginning in the l960s, a growing number of women elected to bear their children without anesthetics, so that they could be fully conscious during childbirth. Many women also chose to have their husbands or a relative or a friend present during labor and delivery and to bear their children in special "birthing rooms" that provide a home-like environment. In these ways, many contemporary women have sought to recapture the broader support network that characterized childrearing in the colonial past, without sacrificing the tremendous advances that have been made in maternal and infant health.
2018
History of American Women: Women in Medicine. (2018). 19th Century Midwives. Accessed https://www.womenhistoryblog.com/2014/06/19th-century-midwives.html
The substitution of doctors for midwives and of hospital delivery for home delivery did little in themselves to reduce mortality rates for mothers. It was not until around 1935, when antibiotics and transfusions were introduced, that a sharp reduction in the maternal mortality rate occurred. In 1900, maternal mortality was not much lower than it had been in the mid-nineteenth century.
2017
Holland, B. (2017). The 'father of modern gynecology' performed shocking experiments on enslaved women. Accessed https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experiments-on-slaves
But because Sims’ research was conducted on enslaved Black womenwithout anesthesia, medical ethicists, historians and others say his use of enslaved Black bodies as medical test subjects falls into a long, ethically bereft history that includes the Tuskegee syphilis experimentand Henrietta Lacks. Critics say Sims cared more about the experiments than in providing therapeutic treatment, and that he caused untold suffering by operating under the racist notion that Black people did not feel pain.
2016
Oakley, A. (2016). The sociology of childbirth: an autobiographical journey through four decades of research. Sociology of Health & Illness, 38(5), 689–705. https://doi.org/10.1111/1467-9566.12400
CONCLUDED: "What I identify here as separate strands in the development of the sociology of childbirth – the heritage of medical sociology, the arrival of a new respect for qualitative research, the impact of the women's movement, the energies of consumer organisations, the drive for evidence-based practice and policy – jostle next to one another in the documentary records. They cannot be separated from one another, except arbitrarily, for the purpose of analysis. The analytic process suggests a need to probe more carefully the interconnections between personal lives and networks, on the one hand, and professional concerns and enterprises, on the other."
Thompson, & Varney, H. (2015). A history of midwifery in the United States: the midwife said fear not. Springer Publishing Company. eBook is accessible for online reading or download at
CONCLUDED (from introduction: "The historical evolution of midwives as respected, autonomous health care workers and midwifery as a profession can be depicted by several important characteristics that are highlighted throughout this text. Th ese characteristics include the close link between midwives and the communities where they live, their shared view of pregnancy and birth as normal life events that sometimes result in less-than-optimal outcomes, midwives’ desire to promote health and prevent sickness whenever they could, and their willingness to be “with women” wherever those women are and whatever the sacrifice for the midwives themselves. However, the midwives’ desire to promote the health of women and families was often threatened and/or undermined by the increasing medicalization of childbearing care (medical monopoly) along with the midwives’ lack of a common identity based on education and practice standards, the lack of legal recognition to practice, and, more recently, reimbursement for autonomous midwifery services"
2014
Al-Gailani, S., & Davis, A. (2014). Introduction to "Transforming pregnancy
since 1900". Studies in history and philosophy of biological and biomedical
sciences, 47 Pt B(Pt B), 229–232.
https://doi.org/10.1016/j.shpsc.2014.07.001
CONCLUDED: (from article) "The most influential writing on
pregnancy from a historical perspective during the 1970s and early 1980s
focused on struggles for the control of childbirth. These accounts presented
late twentieth-century maternity care as the consequence of a historic power
grab that had transformed obstetrics and gynecology into privileged and
powerful professions at the expense of female midwives (Arney, 1982; Donegan,
1978; Donnison, 1977; Ehrenreich & English, 1973). This perspective emerged
in a political context in which not only feminists but also non-feminist
patient consumer organisations were campaigning for the redistribution of
power between medical specialists and pregnant women, and for greater choice
in childbirth (Oakley, 1984, pp. 236–249). Critics of maternity
care—especially in the United States and Britain—argued that by redefining
the ‘natural’ process of childbearing as inherently risky, obstetricians had
deceived women into accepting hospital and medical interference as the rule
for all births (Arms, 1975). Despite their different approaches these
authors shared an understanding of the medicalisation of reproduction as a
process that was, a priori, imposed upon women to their detriment;"
2010
Benoit, C., Zadoroznya, M., Hallgrimsdottir, H., Treloar, A. and Taylor, K. (2010) Medical dominance and neoliberalism in maternal care provision; The evidence from Canada and Australia. Social Science and Medicine. 71(3) 475 – 481 Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445451/
CONCLUDED: "This
neoliberal rhetoric of consumerism provides the justification for the
continuing hegemony of medicine over maternity care in Canada and Australia.
It would be beneficial to investigate the recent history of medicalisation
of maternity care in other high-income countries using our analytical
perspective, as well as to explore counter-neoliberalizing forms of
regulatory restructuring in these countries and their impact on medical
hegemony."
2009
Schram, C. (2009). Maternal History. Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726092/
The New York Maternal Mortality Study was funded by the Commonwealth Fund and conducted by the New York Academy of Medicine from 1930 to 1932. The study found that home births attended to by midwives during this time actually had the lowest maternal death rate and that approximately two-thirds of the maternal deaths that occurred in hospital were preventable.
2008
Brodsky, P. L. (2008). Where Have All the Midwives Gone? The Journal of Perinatal Education, 17(4), 48–51. https://doi.org/10.1624/105812408X324912
ICONCLUDED: (from article" "In response to the small but growing demand for midwifery care and home
birth and to the success of the documentary film The
Business of Being Born (Lake
& Epstein, 2007),
the American Medical Association, in three separate resolutions in 2008,
seeks to limit the scope and practice of midwifery, insure physician and
regulatory oversight of midwives, and promote legislation to insure that all
births take place in hospitals or birthing centers (American
Medical Association House of Delegates, 2008a, 2008b, 2008c).
Childbearing women need to be made aware of the evidence that now exists on
the risks of the routine use of interventions during labor and birth and be
thoroughly informed about the pros and cons of all obstetric interventions."
CONCLUDED (from article) "An
intuitively appealing explanation for the sudden growth of hospitals is that
they offered superior outcomes compared to alternative home-based medical
care. With respect to childbirth, it is not obvious that hospitals
necessarily led to better outcomes; as birth shifted to hospitals, maternal
mortality rates (measured as the number of maternal deaths per 100,000 live
births) did not decline. Fig. 1 shows total, urban (places over 10,000) and
rural maternal mortality from 1915 to 1940. Fig. 2 shows the death rate
among women for tuberculosis and all causes related to childbirth (puerperal
causes) from 1900 to 1940.
2001
Cahill. (2001). Male appropriation and medicalization of childbirth: an historical analysis. Journal of Advanced Nursing, 33(3), 334–342. https://doi.org/10.1046/j.1365-2648.2001.01669.x
CONCLUDED (from abstract) "Male justifications of female inferiority have been developed and nurtured through professional discourses and socialization processes inherent within medical education and practice (Cahill H. 1999 MA Thesis, University of Keele). These assumptions are internalized and reproduced to shape quite profoundly, the nature of doctors' interactions with women in their care. Perhaps more fundamentally, such discursive explanations of women's bodies as inherently defective continue to shape women's position in society. Maternity care is a key area in which women's ability to exercise real choice and make informed decisions is limited and where doctor±patient interactions are themselves constructions of existing gender orders; women's autonomy continues to be violated through both quite subtle and overt discourse and practice."
2000
Cahill, H. (2000). Male Appropriation and Medicalization of Childbirth: A
Historical Analysis. https://doi.org/10.1046/j.1365-2648.2001.01669.x
CONCLUDED: "Male justifications of female inferiority have been developed and nurtured through professional discourses and socialization processes inherent within medical education and practice (5 MA Thesis, University of Keele). These assumptions are internalized and reproduced to shape quite profoundly, the nature of doctors’ interactions with women in their care. Perhaps more fundamentally, such discursive explanations of women’s bodies as inherently defective continue to shape women’s position in society. Maternity care is a key area in which women’s ability to exercise real choice and make informed decisions is limited and where doctor–patient interactions are themselves constructions of existing gender orders; women’s autonomy continues to be violated through both quite subtle and overt discourse and practice."
1996
Tone, A. (1996). Controlling Reproduction: An American History. BOOK accessed https://rowman.com/ISBN/9780842025751/Controlling-Reproduction-An-American-History#:~:text=Controlling%20Reproduction%20is%20an%20informative,%2C%20business%2C%20and%20social%20change.&text=The%20breadth%20of%20Andrea%20Tone's%20project%20is%20its%20greatest%20strength.
1987
Leavitt. (1987). The Growth of Medical Authority: Technology and Morals in Turn-of-the-Century Obstetrics. Medical Anthropology Quarterly, 1(3), 230–255. https://doi.org/10.1525/maq.1987.1.3.02a00020
CONCLUDED: (from abstract) " Before 1880 bortjomg wp,em amd tjeor fe,a;e attemdamt dominated decisions concerning labor and delivery. Between about 1880 and 1920; however, the medical profession gained control of obstetrical care and birth increasingly took place within hospitals. Using the specific example of the debate about performing craniotomies (the surgical mutilation of the fetal head to permit vaginal extraction) on live fetuses, the paper analyzes how technological innovations, changing medical theory, moral and ethical considerations, and professional interests interacted to make physicians more powerful arbiters in America's birthing rooms."
1982
Arney, & Neill, J. (1982). The location of pain in childbirth: natural childbirth and the transformation of obstetrics. Sociology of Health & Illness, 4(1), 1–24. https://doi.org/10.1111/j.1467-9566.1982.tb00245.x Accessed https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-9566.1982.tb00245.x
CONCLUDED (from abstract) "In the post-World War II period obstetrics transformed the nature of its work, partly in response to the challenge of natural childbirth. The transformation is traced by focusing on obstetrics' understanding of pain in childbirth. In reformulating its field of power obstetrics reconstituted its patient-object to take into consideration the patient's subjectivity which, as a result of the natural childbirth movement, had asserted itself, escaping from the confines in which obstetrics had tried to contain it, and reclaiming for a fleeting instant the pain which signalled a woman's active participation in birth."
Last updated June 2024