Medicalization of Pregnancy and Childbirth: The General Goals and Performance

Medicalization is the taking of something that is a part of the normal life experience and making it a medical problem, specifically one that requires treatment. This occurs quite often, especially in the Western world, but there is not example that is more apparent as that of the medicalization of pregnancy and childbirth. That is not say there is no benefit to seeking medical care during pregnancy and childbirth, but rather that something that is a part of everyday life, and has been for the duration of human existence, is not viewed as something requiring the care of doctor. This can be plainly seen by the reaction we can imagine if someone were to say that they were about to give birth and had not even once seen an obstetrician, something that would have once been unremarkable (due to the lack of formal medical care), would now been seen as shocking, and likely negligent. This paradigm shift brings with it added costs and potential stressors, but also can bring many benefits.

To understand this shift we need to look at “normal” childbirth, both in the past and in the present. Beginning in colonial America, childbirth was not the domain of a physician. Instead, “midwives handled most births”. These midwives were actually expected to attend the births, both for those that were wealthy, as well as for the poor. No physicians were involved, yet we see a low mortality rate and low rates of infection. (M&T 155) Beginning in the 17th and 18th centuries, medical intervention in pregnancy began to become much more routine. By 1710, in England, gynecology and obstetrics began to be recognized as a medical specialty, and births were attended, initially at home, but then in hospitals as time went on, at least for the wealthy. (M&T 155) Prior to the start of the 20th century, high maternal mortality rates led to a view of childbirth as dangerous, leading to a decline in the use of midwives and home births. By 1935, 75% of U.S. births took place in a hospital, with that rate rising to 95% by 1960. (M&T 155) Today, we are seeing a slight rise in births not attended by physicians, but by 2011, only about 10% of births were attended by midwives, with just 1% occurring outside of a hospital in the U.S. and Canada in 2009. (M&T 155)

As we have seen, modern birth is almost exclusively based in a medical facility, under the supervision of a medical professional (typically a doctor). While more basic traditions, such as a pregnant woman being encouraged to move around and walk to speed up the early stages of labor still occur, as the process progresses, they are confined to a bed, with equipment attached to monitor the fetus, and an IV in place. (M&T 156,7) If labor takes to long, medication may be used to accelerate the process. The amniotic sac may also be punctured for the same reason. In addition, pain medication can be administered, either by IV, or by epidural, to ease the pain experienced during birth. (M&T 157) If labor continues to drag on, more advanced medical interventions may be required, including surgical delivery, by C-section. (M&T 157) If issues arise during birth, a

Physician may employ different methods to help the process along, such as the use of a vacuum extractor or forceps to ease the passing of the head and shoulders through the birth canal. Another routine treatment is an episiotomy, an incision in the perineum to prevent tearing. Following delivery of the child, the umbilical cord is cut, and the placenta is delivered and weighed. The child is then cleaned, weighed, measured, and its vitals signs are checked. Complications can be dealt with through extended hospitalization of mother or child. (M&T 157)

The C-section itself is a great example of the medicalization of childbirth. A C-section, or cesarean section, is the surgical removal of the child through a 4-6 inch incision into the mother’s abdomen to access the uterus, and the fetus residing there. (M&T 157) Something that would have been unheard of in the times of midwives is now so commonplace that in 2012, 32% of deliveries ended in a C-section in the U.S. (M&T 158) While some of these may be necessary, due to complications with the position of fetus, or other issues that may arise, it has been suggested that rates higher than 25% indicate “defensive medicine” that may be designed more to protect the physician and facility rather than the patient(s). (M&% 158)

As we saw, the old system of midwives did not seem to be causing harm, so why has the basic act of childbirth become such a medical condition? The answer can be explained with one simple question, “What if something goes wrong?” (M&T 158) The thought is certainly terrifying for any prospective parent. And, there is little doubt that they hospital is the best place to be if something does go wrong during childbirth. Having intensive care for mom and baby just steps away provides a security blanket that can never be matched outside of a medical facility. But there is a cost. For starters, the mother and child may miss out on vital bonding time due to medical assessments being rendered. The benefit of bonding between mom and baby is not something that should be taken for granted. It has been stated that, “There is a sensitive period in the first minutes and hours of life during which it is necessary that the mother and father have close contact with the neonate for later development to be optimal.” (B&B 392,3)

There is also the financial cost. It is no secret that babies are expensive, it is often not something that is fully realized with in-depth analysis. A home birth may cost in the area of $5,000 (moneycrashers), while an uncomplicated vaginal delivery in a hospital can be expected to cost around $9,600. A C-section could cost $15,800. (WebMD) It is important to note that medical insurance is much more likely to pay a portion of a hospital birth or a home birth. Now, nobody would think of complaining of the costs involved in ensuring the safe delivery of their child, especially in a society where we tend to believe that “health depends primarily on intervention by a doctor”. (B&B 67)

We also tend to believe that “the essential requirement for health is the early discovery of disease.” (B&B 67) This may explain the other aspect of the medicalization of childbirth, prenatal care. Pregnancy is now shaped around appointments, tests, and dietary supplements. While is undeniable that our diets are often deficient in certain nutrients, and that this can contribute to a host of medical problems for the unborn child, it is baffling that pills are the go-to answer. In addition, we see the prevalence of ultrasounds and sonograms, as well as amniocentesis and genetic analysis, all in an effort to detect the possibility of disease in the unborn child. All of this contributes to stress for the mother. There is something to be said for ignorance being bliss.

There are both costs and benefits that arise from the medicalization of pregnancy and childbirth. The fear that can come from the unknown, especially the “What if something goes wrong?” question can be mitigated by hospital delivery. Almost instantly, emergency care can be there. Prenatal care can help to mitigate the risks of inadequate nutrition, and alert us to potential medical problems, some of which can be fixed before or after birth. However, there is also a cost associated with this. The financial costs can be astronomical for something that has always been a part of everyday life. In addition, critical bonding time can be lost due to the medical assessments that now are a part of childbirth. Beyond that, maternal comfort has been altered. While it once focused on positioning, it has now become an issue of analgesics. We also see the concern for schedules and legal liability influence the very nature of birth. Medication and surgical procedures have become an all too common answer something that has not always been seen as a problem. While there are certainly costs, and benefits, to this shift in pregnancy, I don’t know that it can really be seen in a positive or negative light. It is different; I think that is all that can really be said definitively. Childbirth isn’t what is used to be.