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.

MEDICALIZATION: GENERAL and MISCELLANEOUS RESOURCES

WHAT DOES THE LITERATURE SAY?

2022

Center for Disease Control (CDC). (2022). Pregnancy Mortality Surveillance System. Accessed https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

CONCLUDED: "Information about causes of maternal death. If compared to charts showing growth of non-medical interventions, it can be seen that as interventions such as c-sections increased, so did maternal morbidity. We must be willing to explore cause/effect."

U.S. Whitehouse (2022). White House Blueprint for Addressing the Maternal Health Crisis. Accessed https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf

From report: "While physicians, nurse practitioners, physicians’ assistants, and nurses undoubtedly play an essential role in the maternal health ecosystem, so, too, do social workers, nutritionists, and non-clinical workers, such as community health workers and doulas. For example, access to community-based doulas is associated with improved maternal health outcomes, including lower odds of Cesarean sections and preterm births.98 Yet, only about 6% of women who give birth receive doula care."

2021

Gagnon, R., & Champagne-Poirier, O. (2021). Giving Birth to Another Child: Women’s Perceptions of Their Childbirth Experiences in Quebec. Qualitative Health Research, 31(5), 955–966. https://doi.org/10.1177/1049732320987831

Concluded (material omitted) Therefore, we find it important that health care professionals become aware of the importance of paying attention to what women express to give them the support that corresponds to their wishes and feelings. To promote a positive childbirth experience, it is essential to create a favorable environment and have a respectful attitude regarding the intimate space needed for women to feel confident and able to let go during labor. A change of perspective concerning the role of the professional would also be beneficial. Women, especially those with experience, need professionals who see themselves as resource persons, rather than experts who possess the knowledge. Moreover, it also appears important that doctors and nurses work together with trained midwives while respecting each other’s expertise, as well as the women’s choices."

Harvard Law Review. (2021). Chapter three: The legal infrastructure of childbirth. Harvard Law Review, 134(6), 2209–2232. Accessed https://harvardlawreview.org/2021/04/the-legal-infrastructure-of-childbirth/

CONCLUDED (from article) "The legal infrastructure of birth, through tort law incentives and regulation of midwives, drives lack of access and choice in birth. By shaping the provision of healthcare, law encodes particular values in the birthing process, promoting a fetal-centric and physician-controlled approach. In seeking solutions, advocates should focus on bringing the regulation of childbirth into alignment with healthcare and constitutional law more broadly, and on reforming areas of the law that can improve access to a broader spectrum of care."

Hickey, J. (2021). Nature is smarter than we are;: Midwifery and the responsive state. Columbia Journal of Gender and Law Vol. 40 No. 2 (2020) https://doi.org/10.52214/cjgl.v40i2.8063 Accessed https://journals.library.columbia.edu/index.php/cjgl/article/view/8063

CONCLUDED: "Pregnant women need meaningful and transformative birth experiences free of abuse and unnecessary medical intervention. They need supportive care that allows for safe and healthy birth outcomes. Instead, they are effectively forced to pay top dollar to gi ve birth under a medical and technocratic model that only increases their chance of suffering significant injury or death. Rather than adopting meaningful solutions to its shockingly high rate of maternal and infant mortality, the state holds pregnant women entirely responsible for negative outcomes and criminalizes them for social problems. The private ordering of the doctor-patient relationship, the focus on individual rights and choice in birth, and the myth of the autonomous medical consumer combine to create a system in which the state is absolved of responsibility to address birth injury, despite the collective benefits obtained from the reproduction of society. We must instead envision a responsive state that provides meaningful support for pregnancy and birth by actively seeking to support midwifery and normalize birth without intervention. In this manner, we can find real solutions to the problem of birth injury and transform birth from an adversarial event to a celebratory one."

2020

U.S. Department of Health and Human Services (2020). Surgeon General's Call to Action to improve maternal health. Accessed https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf

The United States has one of the most technologically advanced healthcare systems in the world, yet we have a maternal mortality rate that is higher than comparable countries. Racial and ethnic, geographic, and age disparities are especially concerning: Pregnancy-related mortality for Black and American Indian and Alaska Native women is two to three times higher than for white, Hispanic, and Asian/Pacific Islander women.a The share of rural counties with hospital obstetric services decreased significantly in the past decade, and women over 35 years are one and a half times more likely to experience complications during pregnancy

2019

Brubaker, S. and Dillaway, H. (2019). Medicalization, natural childbirth and birthing experience. Accessed https://compass.onlinelibrary.wiley.com/doi/10.1111/j.1751-9020.2008.00183.x

From abstract: We revisit sociological frameworks and feminist critiques of medicalization, specifically around childbirth, and review scholarship that addresses their limitations. We propose a research agenda that goes beyond the traditional assumptions about ‘natural’ and ‘medical’ childbirth and examines more closely how medicalization processes both shape and conflict with women's subjective experiences of childbirth.

California Healthcare Foundation (2019). Maternity Care in California. Accessed https://www.chcf.org/wp-content/uploads/2019/11/MaternityCareCAAlmanac2019.pdf

One in four in-hospital births in California were low-risk, first-birth cesareans (c-sections). Rates for Black women were six percentage points higher than the Healthy People 2020 goal (23.9%) while rates for Latina and white women met this goal. While critical in some circumstances, c-sections can pose serious risks for baby and mother

McCarthy, & Jones, J. S. (2019). The Medicalization of Nursing: The Loss of a Discipline’s Unique Identity. International Journal for Human Caring, 23(1), 101–108. https://doi.org/10.20467/1091-5710.23.1.101

From article: A graduate student at a prominent mideastern university was enrolled in the adult nurse practi- tioner (NP) program. During a classroom discussion regarding appropriate interventions suited for the advanced practice nurse, the student raised a question regarding the approach to the patient and was informed by the instructor, “You now need to quit thinking like a nurse.” This exchange actually happened. What was most disturbing to the student was that it ran counter to her expectation of expanding her thinking as a nurse as she was, after all, enrolled in a graduate program in Nursing! It created dissonance for her that was not resolved until she reengaged with nursing paradigms in her doctoral program years later. What is more disturbing is that this experience seems to be an exemplar of what is happening, curricular-wise, at both the generalist and the advanced level of nursing practice. The concern generated by this scenario includes, but extends beyond, the individual student’s distress recalled years later in its retelling.

Ranjbar, F., Gharacheh, M. Vedadhir, A. (2019). Overmedicalization of Pregnancy and Childbirth. International Journal of Women's Health and Reproduction Sciences. Accessed https://ijwhr.net/pdf/pdf_IJWHR_406.pdf

Medicalization is regarded as a form of social control and a process through which problems or non-medical experiences are defined and managed as medical problems or diseases. Furthermore, medicine is increasingly dominating the everyday life of individuals (1), thereby resulting in the social acceptance of the medicalized form of human experiences. Via attaching a disease label to natural phenomena, medical professionals expand the scope of their authority, regardless of whether they have the capacity to effectively manage these phenomena (2). The current paper did not intend to undervalue medical achievements, especially in the area of maternity care, but rather, to depict the overmedicalization of the experience of pregnancy and childbirth.

Tari, G. and Hamvai, C. (2019). The medicalization of childbirth: Ethical and legal issues of negative childbirth experience. (Accessed https://trivent-publishing.eu/books/thebioethicsofthecrazyape/16.%20Gergely%20Tari.pdf

CONCLUDED: "Our survey explored the manners in which childbirth experiences are affected by medicalization. The results showed that a significant number of types of medicalization are potentially responsible for negative childbirth experiences. By reviewing the respondents’ answers, several non-medical reasons were found which affect women’s satisfaction at birth. Unwanted, unexplained, or unnecessary medical interventions, disproportionate limitation of self-determination are the most common ethical and legal issues of childbirth. It should also be highlighted that the majority of the respondents prefer a partner-like doctor-patient relationship and shared decision making instead of paternalism. Since hierarchical differences between healthcare practitioners and women increase vulnerability during labour and delivery, it is essential to allow reproductive autonomy and selfdetermination dominate the intrapartum care. Therefore, in line with informed consent, women must be involved in the decision making process after being given comprehensive medical information in an understandable manner. Practitioners must consider women’s preferences regarding the nature and timing of medical interventions, Gergely Tari, Csaba Hamvai 290 position during labour and delivery, and choosing a person/family member to assist them during labour." (material omitted)

World Health Organization (2019). Maternal Mortality Country Profiles Accessed https://www.who.int/data/gho/data/themes/maternal-and-reproductive-health/maternal-mortality-country-profiles

This report presents internationally comparable global, regional and country-level estimates and trends for maternal mortality between 2000 and 2017.

Preis, H., Pardo, J., Peled, Y., & Benjamini, Y. (2018). Changes in the basic birth beliefs following the first birth experience: Self-fulfilling prophecies? PloS One, 13(11), e0208090–e0208090. https://doi.org/10.1371/journal.pone.0208090

CONCLUDED: "Our conclusion is in line with the recent World Health Organization guidelines regarding encouraging intrapartum care practice which contributes to a positive birth experience [34]: Supporting safe physiological birth, avoiding unnecessarily medicalized births [35,36] and improving satisfaction with birth should be a main goal for maternity care providers. Additionally, psychosocial professionals should aim to decrease women's fears, and strengthen their self-efficacy. Doing these would empower women, increasing their beliefs in themselves, their bodies, and the natural course of birth."

World Health Organization (2018). WHO recommendations Intrapartum care for a positive childbirth experience. Accessed https://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf

CONCLUDED (from text) "The WHO intrapartum care model has the potential to positively transform the lives of women, families and communities worldwide. It sets goals beyond the level of merely surviving, but at the level of thriving, in all country settings. The implementation of the WHO intrapartum care model should lead to cost savings through reductions in unnecessary medical interventions, with consequent improvements in equity for disadvantaged populations. Thus, addressing the shortage of skilled maternity care providers and improving the infrastructure required to successfully implement this model of evidence-based intrapartum care should be a top priority for all stakeholders"

2017

Benhamini, Y., Molcho, M., Dan. U., Gozlan, Mr.and Preis, H. (2017). Women's attitudes toward the medicalization of childbirth and their associations with planned and actual modes of birth. DOI https://doi.org/10.1016/j.wombi.2017.03.007 Accessed https://pubmed.ncbi.nlm.nih.gov/28434672/

From Intro: "The dominant birthing model in most of the Western world is medicalized childbirth.1, 2 This is evident in the overall high use of medical interventions, often without any medical indication, such as epidural analgesia, caesarean births, and the controversial option of caesarean birth on maternal request. Caesarean rates are on the rise: in 2014 they accounted for 32.3% and 25.0% of births in Northern America and Europe, respectively.³ Medicalization begins earlier in the pregnancy, with prenatal care that transforms pregnancy into a permanent at-risk condition in need of medical monitoring.⁴ Together with recognizing the benefits of medicalization, there has been growing concern among healthcare professionals that the medicalization of childbirth may have gone too far.⁵ Correspondingly, there have been calls for clinical practice based on evidence-based procedures that would better support physiological birth."

2016

Lennon, S. L. (2016). Risk perception in pregnancy: a concept analysis. Journal of Advanced Nursing, 72(9), 2016–2029. https://doi.org/10.1111/jan.13007 Accessed https://www.researchgate.net/publication/303425269_Risk_perception_in_pregnancy_A_concept_analysis

CONCLUDED: "Every human being who has ever lived is the product of the state of pregnancy, making this the most common physiological process of our species. Yet while pregnancy is common, it is also a completely unique state. Pregnancy is at once an intensely personal experience and one that all of society is vested in. Pregnancy and childbirth are a normal and natural function for a women’s body and yet these process are increasingly seen as being in need of professional surveillance. Women today know more about their developing infant than at any other time in history, but this increased knowledge has not led to a sense of reassurance. In fact, it can be argued that surveillance and testing has had just the opposite effect, with women feeling at increased risk" (material omitted)

Luce, A., Cash, M., Hundley, V., Cheyne, H., van Teijlingen, E., & Angell, C. (2016). “Is it realistic?” the portrayal of pregnancy and childbirth in the media. BMC Pregnancy and Childbirth, 16(1), 40–40. https://doi.org/10.1186/s12884-016-0827-x

CONCLUDED: "However as the recent study by Maclean highlighted; UK newspapers have an interest in horror stories and a tendency to suggest that an absence of obstetricians is dangerous, something that she has termed a ‘hierarchy of safety’ [23]. As printed media is still a major part of the mass media, it is imperative that researchers determine if the discourses put forth in the printed press replicate those broadcasted and online. Lastly, it is important to investigate what media producers know about childbirth and labour and their views on the impact that the current representations may be having on women. It is important for midwives to engage with media producers to help improve the representation of childbirth on television, in the same way that midwives should be encouraged to work more with the press" (material omitted)

Mobarakabadi, S., Najmabadi, K., Tabatabaie, M., and Esmaily, H. (2016). Predictors of mode of childbirth based on medicalizaed maternal care: a cross-sectional study. DOI http://dx.doi.org/10.5812/ircmj.25073 Accessed https://www.proquest.com/docview/1881960939?pq-origsite=gscholar&fromopenview=true

From background: "With the improvement of maternal care, the risks associated with delivery have significantly decreased. This has provided a field for the medicalization of pregnancy and delivery (4). Certainly, delivery can also cause serious complications (5), and without a doubt one of the main goals of care during pregnancy and birth is a significant reduction of such risks (6). But, medicalization of maternal care, in turn, leads to increased reliance on health professionals, especially obstetricians and gynecologists (5), and the overuse of drug and technological and surgical procedures, as well as unnecessary, expensive, dangerous and invasive obstetrical interventions, in low-risk pregnancies and births "

2015

World Health Organization Europe. (2015). Childbirth: myths and medicalization. Accessed https://www.euro.who.int/__data/assets/pdf_file/0007/277738/Childbirth_myths-and-medicalization.pdf

From intro: Undoubtedly medical involvement in childbirth has done much to improve outcomes for many women and their newborns who experience medical or pregnancy related complications, but in recent years there has been increasing evidence that widespread medical involvement in childbirth is not always in the best interests of women experiencing straightforward low risk pregnancies

2014

Every Mother Counts Org. (2014). Over-medicalization of maternal health in America. Accessed https://blog.everymothercounts.org/over-medicalization-of-maternal-health-in-america-40e20e6b4171

From article: Over-medicalization occurs when more medical care is applied to a health condition than is required or recommended to achieve better health. It happens in maternal healthcare in the U.S. all the time. Only 15% of pregnancies will include some level of medical complication, yet our traditional obstetric model of care commonly treats most pregnancies as if they’re at high risk for complications. While there’s no doubt that some pregnancies do require advanced medical care to deliver healthy babies to healthy mothers, most require more basic skilled prenatal and antenatal care to insure safe outcomes

2013

Neiterman, E. (2013). Sharing Bodies: The Impact of the Biomedical Model of Pregnancy on Women’s Embodied Experiences of the Transition to Motherhood. Healthcare Policy, 9(SP), 112–125. https://doi.org/10.12927/hcpol.2013.23595

CONCLUDED: (from abstract) "Once upon a time, pregnancy was not medicalized. Referring to the magic of nature or other mysterious forces, women might understand their pregnancy as a blessing or a curse from God. None of us can remember this time. For most women who grew up in Western culture, the nature of pregnancy and birth is anything but mystical. We know how and why women can become pregnant, we know the mechanics of pregnancy and birth, and we make sure that women stay on medically established track during pregnancy. The medicalization of pregnancy has taken away more than just its mystical aura. Many feminist scholars have criticized biomedicine for transferring control over reproduction from expectant mothers to medical specialists (Davis-Floyd 1990; Katz Rothman 1993; Oakley 1980). This transition is seen as alienating for many women, separating them from their bodies and making them passive recipients of medical care (Martin 1984)."

O’Malley, A. (2013). Preventing a return to twilight and straitjackets; using the patient protection and affordable care act as a starting point for evidence-based obstetric reform in the United States. Northwestern Journal of Law & Social Policy, Vol. 8(2). Accessed https://scholarlycommons.law.northwestern.edu/cgi/viewcontent.cgi?article=1106&context=njlsp

CONCLUDED: "For the sake of women and babies in the United States and the future of our society, the maternal experience could significantly improve through obstetric healthcare reform. Financial motivations should not take precedence over quality healthcare. Quality healthcare is a basic human right that all women in the United States should have access to and such care should be supported through fundamentally sound, evidence-based standards of care."

2012

Calnan, S. (2012). (STUDENT WORK) The medicalization of birth and its effects on women’s perceptions of birth. Accessed https://dl.tufts.edu/downloads/z603r9259?filename=r494vx35h.pdf OR https://doi.org/10.1016/S0140-6736(18)30001-1

CONCLUDED: "My results from the participants’ interviews confirm the dominance and prevalence of the medicalization of birth in America. Nineteen of my 20 participants all planned to have a medicalized birth. This preference is a concern because this model is associated with health complications for both the mother and infant. The extreme embodiment of the medicalization of birth is the scheduled C-section. Twenty percent of my sample would choose to have a C-section over a vaginal birth; add 10% for medically necessary C-sections, and my sample nearly reflects the national C-section rate of 32.8%. The media—which portrays and perpetuates the medicalized version of birth—is the main, and often the only, source of information on birth for my sample. Instead of ignoring this outlet of information, I recommend harnessing the media as a way to spread positive and helpful information regarding birth."

Johnsdottir, O. (2012). Medicalisation of childbirth in western society; Can women resist the medicalization of childbirth. Accessed https://skemman.is/bitstream/1946/11156/1/Mannfr%C3%A6%C3%B0i%20BA%20ritger%C3%B0%20-%20Oddn%C3%BD%20Vala%20J%C3%B3nsd%C3%B3ttir.pdf

CONCLUDED: "To answer the question posed as the title of this essay, women can resist the medicalisation of childbirth, but it is difficult because of the structures of power, risk and normalisation. Sheila Kitzinger (2005) says that what needs to be done is to build bridges between the medical environment of birth and women. The health professionals who want to give women-centred care that is based on informed choice need support to do so. The birthing environment needs to improve so women feel supported in birthing their babies in all forms, whether it be at home, within the hospital, with assistance of technology or without it. This is the fluidity that Foucault spoke about in regards to the relationship between authority and the individual so as to create a normality that everyone agrees to." (material omitted)

2008

Johnson, C. (2008). The political "nature" of pregnancy and childbirth. The Canadian Journal of Political Science 41L4. Accessed: https://www.jstor.org/stable/27754405

From "Abstract.In this paper, I examine the theoretical debates concerning “medicalization” in relation to the empirical trend toward increased demand for “natural” options for childbirth. Many feminist theorists have argued that medical intervention in pregnancy and childbirth is both unwarranted and disempowering and devalues women's own abilities and experiences. Further, it is argued that medicalization (of seemingly natural events) is particularly damaging for women and other marginalized people. In this paper, I explore the claims (of both providers and consumers) concerning medical care for pregnancy and childbirth among privileged populations and ask why rejection of medical care for pregnancy and childbirth is not proportional to disadvantage. It appears to be the case that criticism of medical intervention in pregnancy and childbirth is strongest among privileged women and is expressed consistently as preference for “natural,” “traditional” or “normal” approaches and practices."

Parry. (2008). “We Wanted a Birth Experience, not a Medical Experience”: Exploring Canadian Women’s Use of Midwifery. Health Care for Women International, 29(8-9), 784–806. https://doi.org/10.1080/07399330802269451 Accessed https://www.tandfonline.com/doi/full/10.1080/07399330802269451

CONCLUDED: "Further exploration on women's lived experiences with pregnancy will broaden an understanding of women's experiences with pregnancy in a medicalized ideological context. The findings reinforce previous criticisms of the medicalization of pregnancy (Woliver, 2002) and further indicate the inadequacy of a narrow medical model for understanding women's experiences with pregnancy. Clearly, pregnancy and childbirth are life-altering events for women—the memories of which will accompany her a lifetime (Lundgren, 2004). Given that motherhood represents such a life-defining change for women around the world, understanding pregnancy is vital as it is such an important transition point (Fox & Worts, 1999). Moreover, Woliver (2002) noted, “The modern women's movement includes a women's health component, disenchanted with many medical practices and seeking to empower women to be better informed and more assertive consumers of health care” (p. 41). Clearly, research on women's resistance takes up and explores how women can be more active and assertive consumers of health, which is needed now as much as ever. Perhaps Inhorn (2006) sums up this perspective best when she states, “The technological excesses of biomedicine in the face of ongoing medicalization require constant surveillance and vigilance to prevent unnecessary medical control over women's lives” (p. 356)."

Romano, A. M., & Lothian, J. A. (2008). Promoting, Protecting, and Supporting Normal Birth: A Look at the Evidence. Journal of Obstetric, Gynecologic & Neonatal Nursing, 37(1), 94–105. https://doi.org/10.1111/j.1552-6909.2007.00210.x Accessed https://www.jognn.org/article/S0884-2175(15)33712-6/fulltext#relatedArticles

CONCLUDED (from abstract) "Interfering with the normal physiological process of labor and birth in the absence of medical necessity increases the risk of complications for mother and baby. Six evidence-based care practices promote physiological birth: avoiding medically unnecessary induction of labor, allowing freedom of movement for the laboring woman, providing continuous labor support, avoiding routine interventions and restrictions, encouraging spontaneous pushing in nonsupine positions, and keeping mothers and babies together after birth without restrictions on breastfeeding. Nurses are in a unique position to provide these care practices and to help childbearing women make informed choices based on evidence."

2002

Johanson, Newburn, M., & Macfarlane, A. (2002). Has The Medicalisation Of Childbirth Gone Too Far? BMJ,324(7342), 892–895. https://doi.org/10.1136/bmj.324.7342.892 Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122835/

CONCLUDED: "If the growing trend towards medicalisation is to be halted and reversed, the “blame and claim” culture must be addressed. Childbirth without fear should become a reality for women, midwives, and obstetricians. True team working is needed, with development of a shared philosophy of care and mutual respect. The maternity services liaison committee is, and will continue to be, a useful forum for clinicians from all relevant disciplines to work together with informed user representatives and input from pregnant women and new parents, on initiatives to continuously improve the quality of care. Reviewing the available clinical evidence, and learning lessons form individual cases, is important. What is known about women's wishes and fears should also be addressed, so that women centred, clinically effective services can be developed."

1999

Fox, B. and Worts, D. (1999). Revisiting the critique of medicalized childbirth: A contribution to the sociology of birth. Gender and Society. Vol 13, Accessed https://doi.org/10.1177%2F089124399013003004

From Abstract: The women we interviewed displayed widely ranging reactions to giving birth in the hospital. Describing their experiences, these women often emphasized pain and anxiety. Both conditions appear to have been relieved as effectively by social support as by medical assistance. Furthermore, women who had generally supportive partners were less likely to receive medical intervention during the birth and less likely to suffer postpartum depression

1992

Conrad. (1992). Medicalization and Social Control. Annual Review of Sociology,18(1), 209–232. https://doi.org/10.1146/annurev.so.18.080192.001233. Accessed https://www.researchgate.net/publication/234838406_Medicalization_and_Social_Control

CONCLUDED: asks "What is the relationship between the economic structure of healthcare - primarily insurance reimbursement - and medicalization? What is the effect of continuing rising health costs and subsequent policy concerns with cost containment? Does this fuel or constrain medicalization and how? What impact should universal health insurance have on medicalization? "

INTRODUCTION PAGE

Last Updated June 2024