Midwives' professionalization: A comparative approach. An interpretation of the phenomenon of childbirth medicalization

• Author: Elena Spina
• Position: Department of Social Sciences<I> D. Serrani</I>, Polytechnic University of Marche Region.
• Pages: 173-180

Page 173

1. Introduction

The present historical period is characterized by a growing trend towards the medicalization of deviant forms of behaviour. The phenomenon is on the increase and has gradually been expanding to other sectors of human life, such as birth and death, though these are not properly parts of the concept of disease. This brings forward considerations on the existence of a general process of life medicalization that distorts life natural development by forcing people to comply with a whole series of obligations. By medicalization we mean excessive and inappropriate human\ medical intervention on non pathological events.

The present study analyzes this phenomenon with specific reference to the processes of pregnancy and delivery.

It is extremely complicated to establish the causal relationship between medicalization and the diffusion of scientific-medical thought, and that between the emergence of new needs and the induction of care demand. Wagner (1998) attributes the origin of pregnancy and childbirth medicalization to childbirth hospitalization and to the implementation of antenatal care programmes (gradually developing into childbirth care). According to him, the two factors aroused the interest of medicine in reproduction, whose jurisdiction was then transferred from a social to a medical area of competence.Page 174

Foucault studies this aspect in depth and speaks of "indefinite medicalization", maintaining that "today, no field is any longer extraneous to medicine", since "the predominance attributed to pathology has become a general form of society regulation" (2001, 159).

This last aspect raises questions on the correlation between the need for medical intervention and the inducement of demand for medical intervention.

In fact, if on the one hand the need to reduce maternal and child mortality and the pathologies connected with pregnancy has legitimated medical intervention, on the other hand it is not completely clear how and why that intervention has been extended well beyond its real needs. It would be important to understand how much influence has been exerted by the socio-cultural and economic and political changes on the management of the childbirth process, with reference to authoritarian medical power and its ability to impose itself "as an act of authority on each individual, both healthy and ill" (Foucault, 2001, 156).

The question is not easy to answer, since a complex series of diverse factors intervenes in the definition of the problem: technical and scientific progress, the slackening of solidaristic links, the crisis of once consolidated institutions such as the family, the deferral of women's child-bearing years, etc.

All these factors are linked in their turn with wider processes that have gradually modified individual and collective habits and life styles.

2. Objectives and Methodology

The objective of the present study is the individuation of institutional answers to the problem of pregnancy and childbirth medicalization. The starting points of the analysis were WHO recommendations formulated more than 20 years ago (May 1985) and concerning the appropriate use of technology. Those recommendations were based on empirical evidence (EBM) and were aimed at the naturality of childbirth and at reduction in the practises of medicalization (limitation in the number of caesarean sections within a range of 10-15%). Starting from the assumption that birth is a physiologic event, WHO recommendations were also suggested by the need to limit health care expenses, continuously growing owing to the increase in the number of surgical interventions and the length of post-partum hospitalization.

These recommendations were implemented in different periods and differently interpreted by the various countries. The differences are due to a whole series of different factors, ranging from the existence of different historical traditions, to the consolidation of very different cultural trends on the theme of childbirth, from the organization of social services to the sedimentation of different models of professionalism.

On the basis of such assumptions, the present study tries to investigate the actual causes of the present extreme medicalization, in order to evaluate possible alternatives so as to face the problem of medicalization at the institutional level.

The choice has been to study this phenomenon through the analysis of the historical evolution of the midwife's role, in the opinion that the inclusion\exclusion of this professional figure on the scene of delivery reflects the prevailing approach to maternity within a certain context.Page 175

A historical-comparative perspective has been adopted, taking into consideration two different countries: Italy and England which, though showing some analogies, are deeply different under other aspects.

The analysis has made use of qualitative methodology, and is based on two distinct research strategies: the ethnographic method in the study of the Italian case and interviews in depth to study the British case. The empirical phase has been preceded by careful secondary analysis of international literature on the...