The following article is the first in a three part series discussing the history of pregnancy as a medical concept and historical changes of how pregnancy was treated from the times female midwives dominated the field, to the shift of a male dominated doctoral profession.
Photo credit: All Photos Are My Own and Are Property of @marxrab. Taken during my pregnancy and/or hospitalization after childbirth.
The Medicalization of Pregnancy and Childbirth
The medicalization of pregnancy and childbirth first began appearing in the 19th century and is now a dominant way of perceiving processes that were once considered natural.
The process of medicalization is a social process that focuses on the “biomedical tendency to pathologize otherwise normal bodily processes and states” (Inhorn 2006).
Medicalization is a concept that deals with what is defined as healthy and what is defined as illness in society. The process of medicalization in modern societies involves taking a naturally occurring process like pregnancy or childbirth in women and redefining these processes as disruptions to health requiring medical treatment. Because pregnancy is seen as disrupting health, the processes of being pregnant and giving birth are overseen by medical professionals who act as authority figures within the settings of clinics and hospitals.
Increased medicalization of pregnancy and childbirth has changed the way medicine treats these conditions and the way society perceives these concepts having both positive and negative impacts. Even though medicine has made major advances due to medicalization, there have been movements since the 1960s that challenge medicalized ideologies to redefine pregnancy again as being natural processes and new alternative birthing practices have been developed as a response to criticisms.
History: From Female Midwives To A Male Dominated Profession
Medicine first became professionalized in the 1800s in the U.S. Because of the professionalization of the field, how pregnancy and childbirth were handled changed over time. During the 18th century midwifery was systematically devalued by medical practitioners. Midwifery declined greatly during this time period due to the pursuit to professionalize medicine. Medical practitioners argued that midwives were untrained and incompetent, and that pregnancy was a dangerous condition that should be treated only by trained specialists (Cahill 2000).
Reports were published by doctors in the medical field recommending that all women be hospitalized during child delivery. It was recommended that patients avoid going to midwives and choose hospital care instead because it was safer to have trained, educated professionals in charge. Because of the increasing authority and trust people put in medical practitioners, the rates of midwife usage steadily decreased over time. Midwives attended approximately half of all births in 1900, but less than fifteen percent by 1935 (Rooks 2006). The medical community pushed the importance of scientific knowledge of biological processes so that control over pregnancy and birth was transferred from domestic areas to public areas and the field moved to be dominated by male medical practitioners.
The Dangers of Early Professionalized Medicine
It was changes in the medical field due to professionalization that eventually led to the medicalization of pregnancy and childbirth through the redefining of the meaning of pregnancy and changes in medical practices concerning pregnancy. Medicalization was achieved because of claims by the medical community that having male medical attendance during childbirth was necessary and the dangers of childbirth were exaggerated to frighten women into supporting medical ideologies. Giving birth was made out by physicians to be a process that was damaging to mothers and their babies. Interventions (the use of sedatives, episiotomies, ether, and forceps) were designed and advertised as solutions to make childbirth safer and more successful even though early medical practices may not have been safer.
Before the 1900s medical knowledge and practices were limited and sometimes dangerous to patients’ health (Cahill 2000). Flaws in early medical practices could be seen when midwifery declined. Statistically the incidence of mother and infant deaths from childbearing or birth injuries increased because of medical practices and limited medical knowledge about obstetrical interference during childbirth. Studies indicate that there was a forty-one percent increase in infant mortality due to birth injuries between 1915 and 1929 due to obstetrical interference in birth (Rooks 2006).
End of Part 1. Part 2 will discuss pregnancy and childbirth in modern times to understand how current society treats pregnancy and childbirth.
To read more about Medicalization check out my introductory post about this topic here.
Bibliography
Cahill, Heather. 2000. “Male Appropriation and Medicalization of Childbirth: An Historical Analysis” Journal of Advanced Nursing. 33(3): 334-342
Inhorn, M. C. (2006). Defining women’s health: A dozen messages From More Than 150 Ethnographies. Medical Anthropology Quarterly. 20(3): 345–378.
Ivry Tsipy and Elly Teman. 2008. “Expectant Israeli Fathers and the Medicalized Pregnancy: Ambivalent Compliance and Critical Pragmatism.” Culture Medical Psychiatry. 32: 358-386
Johnson, Candice. “The Political Nature of Pregnancy and Childbirth.” Canadian Journal of Political Science. 41(4):889–913
Kukla, Rebecca and Wayne, Katherine, "Pregnancy, Birth, and Medicine", The Stanford Encyclopedia of Philosophy.
Parry, Diana 2008. “We Wanted A Birth Experience, not a Medical Experience: Exploring Canadian Women Use of Midwifery.” Health Care for Women International. 29: 284-806
Rooks, Judith. 2006. “The History of Childbearing Choices in the United States.” Midwifery & Childbirth in America
Zadoroznyj, Maria 1999. “Social class, social selves and social control in childbirth.” Sociology of Health & Illness. 21(3):267-289
