Running head: MEDICALIZATION OF PREGNANCY AND CHILDBIRTH

1






The Medicalization of Pregnancy and Childbirth, Its Effects, Feminist Response, and Who it
Leaves Out: An Overview
Amanda Driver
North Carolina State University













MEDICALIZATION OF PREGNANCY AND CHILDBIRTH 2
The Medicalization of Pregnancy and Childbirth, Its Effects, Feminist Response, and Who it
Leaves Out: An Overview
Introduction
Prior to the turn of the 20
th
century, only a very small percentage of pregnant people saw
a physician prior to childbirth, normally only because they had very severe complications
(Barker, 1998). Now most pregnant people see physicians regularly for prenatal care (Barker,
1998). Medicalization refers to the expansion of the medical jurisdiction into areas that were
previously non-medically defined (Cahill, 2001). This literature review will document the
chronology of the medicalization of pregnancy and childbirth, the effect it and the growing
natural childbirth movement have had on pregnant peoples choices, and how medicalization
and feminist critique of medicalization have still largely ignored the experiences of oppressed
minorities.
Chronology of Medicalization
The 18
th
century saw practitioners in groups such as physicians and surgeons attempt to
discredit unlicensed practitioners (Cahill, 2001). The former group was male-dominated and
educated in upper levels of academia while the latter group included those such as midwives,
typically groups dominated by women (Cahill, 2001). These medical practitioners with their
greater scientific knowledge began to systematically dispute and discredit the knowledge of
midwives (Cahill, 2001). Midwives, as a profession, suffered from a lack of organization and
regulation, but before this time they had no need to be an organized profession requiring
licensure. Midwives were typically women in the community that had been pregnant themselves
or the mothers before them had been midwives and passed down the knowledge (Cahill, 2001).
There was little support for training and development for midwives because women were
MEDICALIZATION OF PREGNANCY AND CHILDBIRTH 3
excluded from many formal educational institutions at this time (Cahill, 2001). This push of
medical practitioners into new areas re-conceptualized childbirth from a normal and attended
to event in life to an abnormal crisis that had to be managed (Cahill, 2001).
In the early 20
th
century, the United States Childrens Bureau created a campaign that
introduced women to a medical conception of pregnancy, one of the hallmark pieces of this
campaign being the handbook entitled Prenatal Care (Barker, 1998). Prenatal Care was first
issued in 1913 and was intended as a resource to consult about pregnancy and upcoming
childbirth. This document stressed the importance of medical supervision while pregnant
(Barker, 1998). This placed pregnancy in a disease model that legitimized the presence of
medical doctors and at the same time delegitimized the experiential knowledge of pregnant
persons (Barker, 1998). Placing pregnancy in a medical model also meant that symptoms and
experiences were either considered normal or abnormal. The introduction of medical
technologies such as the stethoscope, urinalysis, and blood pressure screening gave physicians
more knowledge that was unobtainable by the pregnant person (Barker, 1998). This new
knowledge also meant a widening of the power differential between the pregnant person and the
doctor, because technology was trusted more than the person giving birth (Brubaker & Dillaway,
2009). Prenatal Care also used language that deliberately scared pregnant people into the
doctors offices for supervision, lest the pregnancy turn into a crisis that could only be managed
by a physician (Barker, 1998).
Effects of Medicalization and Feminist Response
This relatively new medical conception of pregnancy and childbirth has had some effect
as well as the pushback to medicalization, often referred to as the natural childbirth movement.
Placing pregnancy in an disease model calls for the supervision of medical professionals (Barker,
MEDICALIZATION OF PREGNANCY AND CHILDBIRTH 4
1998). This creates an inherent power differential between the pregnant person and the
physician. Pregnant people are deliberately frightened by exaggerations of the dangers of
childbirth, and told that to alleviate these fears they should routinely see a physician (Cahill,
2001). This fear and power differential places the physicians scientific knowledge as superior to
the pregnant persons experiential knowledge of their own body and their own pregnancy.
Placing pregnancy in an disease model also justifies the supervision of reproductive organs
(Brubaker & Dillaway, 2009). This supervision means that certain professionals will be
designated as experts in pregnancy because of their scientific knowledge and professional
licensure (Barker, 1998). This is problematic because the pregnant person may no longer be able
to control certain aspects of their pregnancy because their needs and wishes could be overridden
by the medical expert (Brubaker & Dillaway, 2009). Pregnancy treated as a sickness and
medical supervision means that the vast majority of births now take place in a hospital setting
(Barker, 1998; Brubaker & Dillaway, 2009). Physicians tend to seek to actively manage labor
rather than letting it progress naturally, with naturally usually meaning there is little to no
medication or supervision such as a fetal heart monitor (Brubaker & Dillaway, 2009). Many
times hospital interventions, such as inducing labor, require subsequent medical interventions,
such as an epidural, to ensure a successful delivery (Brubaker & Dillaway, 2009).
Medicalization and increased use of vital statistics in the 20
th
century have created greater
scrutiny of reproductive processes and pregnancy (Fordyce, 2013). Prior to the 20
th
century there
were not discrete definitions or categories when using the terms stillbirths, miscarriages, and
abortions (Fordyce, 2013). Medicalization and the introduction of more technology called for
creating specific definitions and discrete categories for the early parts of life (Fordyce, 2013). A
shift in thinking took place in the 1920s, stillbirths went from being regarded as regrettable, but
MEDICALIZATION OF PREGNANCY AND CHILDBIRTH 5
an otherwise natural part of life, to linking it to maternal health, meaning it was preventable, but
this also placed responsibility on the pregnant person (Fordyce, 2013). Public health advocates
wanted to better pinpoint infant mortality to try and prevent it, which led a movement to
subdivide infant death into smaller and more discrete categories (Fordyce, 2013). Predominant
causes of premature labor such as toxemia, syphilis, and continuous overwork during later
months of pregnancy, were linked as pathology of the pregnant persons body, therefore
legitimizing the increase in surveillance of these pregnant bodies, as well as the persons
behaviors (Fordyce, 2013).
Medicalized birth is highly visible and understandable, so many people are unaware of or
unable to conceptualize the natural childbirth movement (Brubaker & Dillaway, 2009). The
natural childbirth movement seeks for pregnant people to define their own pain level and wish
for pain medications. Even though the natural childbirth movement seeks to let people choose,
some pregnant people feel judged for the use of pain meds (Brubaker & Dillaway, 2009). Rather
than a spectrum of choices, people feel as though there is a dichotomy of choosing pain
medication, or choosing no pain medication whatsoever. Rather than expanding the choices of
pregnant people, the natural versus medical dichotomy still seems to limit the choices of
pregnant people. The response of the natural childbirth movement has perhaps, unintentionally,
created a dichotomy of child birthing experiences, rather than help recognize that people have a
wide range of experiences (Brubaker & Dillaway, 2009). Increased interest in natural childbirth
may paradoxically create increased scrutiny and medical surveillance since hospitals may
incorporate some elements of natural childbirth in a hospital setting, but this is not considered
an actual expansion or increase in natural childbirth (Brubaker & Dillaway, 2009). The
natural model of childbirth is a response to the medical model, it has not been defined or
MEDICALIZATION OF PREGNANCY AND CHILDBIRTH 6
assessed in isolation (Brubaker & Dillaway, 2009). There has not been extensive study on the
subjective experiences of pregnant people giving birth, most research has explored the setting of
childbirth and what medical interventions are used or not used (Brubaker & Dillaway, 2009). For
those giving birth, having control over decision making may be more important that birth setting
or medical interventions used when framing their experience as medical or natural (Brubaker
& Dillaway, 2009).
Ignored Experiences of Oppressed Minorities
Both medicalization and feminist critique of medicalization have still largely ignored the
experience of oppressed minorities giving birth, especially among the intersections of race, class,
and at times, age. The medical model of pregnancy and childbirth uses science which creates a
normal composite of the human body, which also creates a normal versus abnormal dichotomy
(Barker, 1998). This normal composite that is created is that of a middle-to-upper class white
woman (Barker, 1998; Brubaker & Dillaway, 2009). Some of the guidelines in Prenatal Care
assumes all pregnant people have the same access to resources and same autonomy to make
decisions about their pregnancy (Barker, 1998). Though Prenatal Care claims to have a class
neutral stance, many suggestions were aimed at pregnant people that are middle-to-upper class
(Barker, 1998). The guidelines do not have exceptions for pregnant people that do not have the
same freedoms or access to resources. Similar to Prenatal Care, the natural childbirth
movement reflects a class and race bias; many of the feminist critiques of medicalization
presupposes that all pregnant people have similar access to cultural and material resources in
order to make an informed decision (Brubaker & Dillaway, 2009). Feminist critiques of
medicalization tend to focus on how privileged individuals are denied choice and control rather
MEDICALIZATION OF PREGNANCY AND CHILDBIRTH 7
than focusing on how medicalization differentially provides or denies reproductive choices based
on social location (Brubaker, 2007).
Brubaker (2007) interviewed 51 African American teen mothers that were from low-
incomes families to try and understand their experience with pregnancy and childbirth and how
medicalization affected them in making choices. Before the teens became pregnant, formal
health care or medical knowledge was largely absent from their experience (Brubaker, 2007).
There is much scrutiny of African American females sexuality, with mothers of these teens
attempting to protect themselves and their daughters from additional stigma and blame
(Brubaker, 2007). Though African American females are hyper sexualized, they also have to
contend with the image of feminine chastity, so many did not have knowledge and/or access to
birth control methods (Brubaker, 2007). Many of the teens accepted or even embraced aspects of
medicalization. For many teens, it was the first time they experience regular health care
(Brubaker, 2007). Medicalization allowed the teens to normalize pregnancy and elevate their
identity as their actions aligned with those seen as responsible and healthy pregnant people
(Brubaker, 2007). Many teens also valued medical care as having the potential to ensure a
healthy outcome (Brubaker, 2007). However, the teens also resisted and rejected certain aspects
of medicalization. Many used their intuition and judgment to resist or reject either physicians
advice, such as diet, or interventions, such as an epidural (Brubaker, 2007). Those that critiqued
medicalization emphasized valuing their own knowledge and recognizing their autonomy in the
situation (Brubaker, 2007).
Conclusion and Personal Observations
The understanding and conceptualization of pregnancy has shifted dramatically within
the past 100-150 years (Barker, 1998; Cahill, 2001). Currently pregnancy is mostly
MEDICALIZATION OF PREGNANCY AND CHILDBIRTH 8
conceptualized within a medical model as a situation to be managed rather than a normally
occurring life event (Barker, 1998; Brubaker & Dillaway, 2009). Feminist critique of
medicalization has addressed that medicalization can deny the choice and control of pregnant
people and that pregnant peoples bodies and behaviors have faced increase medical surveillance
(Barker, 1998; Brubaker & Dillaway, 2009; Brubaker, 2007; Fordyce, 2013). The natural
childbirth movement has been a response to the increased medicalization of pregnancy, although
it is still unsure whether this movement has actually expanded the birthing choices for pregnant
people (Brubaker & Dillaway, 2009). Both medicalization and the feminist response have not
adequately addressed the needs and experiences of minorities that are pregnant, especially at the
intersections of class and race (Barker, 1998; Brubaker & Dillaway, 2009; Brubaker, 2007). Both
of these stances presupposes all pregnant people as having similar access to resources and
knowledge to that of a middle-to-upper class white female (Barker, 1998; Brubaker & Dillaway,
2009; Brubaker, 2007).
Neither the medical nor natural conception of childbirth adequately captures and
describes the full spectrum of pregnant peoples experiences. Some pregnant people may feel
restricted by medicalization, while others may feel empowered with newfound medical
knowledge. What may be more important than birth setting or presence of medical interventions
is that pregnant people have access to knowledge and resources in order to make decisions and
feel as though they have autonomy over their body. Both medicalization and a feminist response
fail to account for the pregnancy and childbirth experiences of oppressed minorities, leading to
further oppression. There has not been enough research into the subjective experiences of
pregnant people with various identities. Instead of a dichotomy between medical and natural,
pregnancy and childbirth need to be re-conceptualized as a spectrum of experiences.
MEDICALIZATION OF PREGNANCY AND CHILDBIRTH 9
References
Barker, K. K. (1998). A ship upon a stormy sea: The medicalization of pregnancy. Social Science
& Medicine, 47(8), 10671076. doi:10.1016/S0277-9536(98)00155-5
Brubaker, S. J. (2007). Denied, Embracing, and Resisting Medicalization: African American
Teen Mothers Perceptions of Formal Pregnancy and Childbirth Care. Gender and
Society, 21(4), 528552.
Brubaker, S. J., & Dillaway, H. E. (2009). Medicalization, Natural Childbirth and Birthing
Experiences. Sociology Compass, 3(1), 3148. doi:10.1111/j.1751-9020.2008.00183.x
Cahill, H. A. (2001). Male appropriation and medicalization of childbirth: an historical analysis.
Journal of Advanced Nursing, 33(3), 334342. doi:10.1046/j.1365-2648.2001.01669.x
Fordyce, L. (2013). Accounting for fetal death: Vital statistics and the medicalization of
pregnancy in the United States. Social Science & Medicine, 92, 124131.
doi:10.1016/j.socscimed.2013.05.024