Mae Czerwiec
I’ve heard the story of my birth hundreds of times. I think it’s a source of great pride for my mother. I was born a week after my due date in a large hospital close to home, but my mother certainly didn’t have the typical hospital experience. She still keeps in touch with her treasured midwife through Facebook, and cheerfully recalls the squats she did in her hospital room– she did not have an epidural, was never sedated or hooked up to any machines, and was allowed to walk around up until the time when she gave birth to me (without surgical intervention) at 9:03 pm on November 30, 2001. I was of average size and weight and healthy, spending no time in the NICU. Though I still have no desire to ever give birth myself, I’ve always thought of my mother’s story as charming, celebratory, and full of agency and support.
Childbirth
So it was jarring to come to find out that my mother’s story is not the typical one. Though one survey of mothers in California found that 74% of them were against interventions in childbirth unless medically necessary, only 5% of that same group reported giving birth with no major medical intervention (California Health Care Foundation 2018). Most of these women were immobilized (61%) or had an epidural (68%) (California Health Care Foundation 2018), which is a far cry from my mother’s robust lower-body workout. Furthermore, 31% of these women had a C-section (California Health Care Foundation 2018), despite the fact that the World Health Organization recommends that all of its member nations avoid Cesarean section rates in excess of 10-15% (WHO 2015). In the context of what we know of the many issues with US healthcare, I was surprised to find that high rates of C-section alone are not a uniquely American problem. In the past 20 years, C-section rates in Canada, Italy, and the United Kingdom have all been around 20%, Spain has seen a C-section rate of 26.4% in Catalonia alone, and in Brazil, the C-section rate has been nearly 36% (Johanson et al. 2002).
“…when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases. When the rate goes above 10%, there is no evidence that mortality rates improve.”
World Health Organization, 2015
Of course in countries with high infant mortality rates, it would be beneficial for more women to have access to obstetric care; however, the consensus of many recent studies seems to be that medical intervention in the case of low-risk pregnancies is unnecessary, and has the potential to do more harm than good. For example, C-sections have been shown to have a global impact on maternal mortality and morbidity (Phelan and O’Connell 2015). I can’t help but wonder how much of this problem is tied to our view of women’s bodies as factories for reproduction, in desperate need of oversight and regulation, and a still-widespread societal belief that women are somehow incapable of making their own choices. Even my mother, a staunch Catholic who opposes the pro-choice movement for abortion access, has to admit that she was privileged enough to enjoy more choice than most mothers in her birth experience.
Breastfeeding
And certainly the medicalization of motherhood doesn’t stop once a child has left the womb. I think of my mother’s best friend, a pediatric nurse practitioner in Chicago, who has recently begun a side business as a lactation consultant. This role allows her to extend her practice to the task of assisting mothers with their concerns related to breastfeeding. In the 20th century, when infant formula was introduced by drug companies, breastfeeding came to be seen (like other issues of female reproduction, such as menstruation) as an arena of female inadequacy: that mothers were incapable of producing enough breast milk to satisfy the nutritional needs of their growing children. Even today, writes author Jennifer Torres, “breastfeeding continues to be constructed as likely to fail, and therefore, in need of medical management” (Torres 2014). Breastfeeding is also a complex issue for reproductive healthcare and women’s bodily autonomy, since women have at different points in history faced both glorification and demonization for their choice to either breastfeed or not breastfeed.
“breastfeeding continues to be constructed as likely to fail, and therefore, in need of medical management”
Jennifer Torres, 2014
Parenting
Disturbingly, there doesn’t seem to be an end to the ways in which we medicalize motherhood. Societally, of course, we have a problem of parent-shaming, pitting the parenting style that works for one family against the perceived failure of another parent’s style, both in private and public spheres. I’m almost ashamed to admit that I’m currently watching the tv series “The Parent Test” on Hulu, where twelve sets of parents are presented as exemplars of their particular parenting “styles” and then put through “challenges” with their children and families to effectively determine which style does the best job of raising well-adjusted children. But aside from sensationalizing or merely judging other parents, we as a society have also medicalized parenthood. In one article, author Ara Francis writes that “Parenting, especially mothering, has become an anxious endeavor, characterized by pervasive self-doubt and guilt” (Francis 2012). Francis’s paper concludes that parents, especially mothers, are subject to increased negative labeling when their children have “invisible disabilities”, such as learning disabilities, developmental disabilities, mental health problems, drug addiction, or other medical problems, and she posits that this negative stigmatization is a direct result of the medicalization of childhood (Francis 2012). The particular burden on mothers is consistent with the theme present in the issues of both childbirth and breastfeeding: that women and their bodies are perceived in terms of deficiency.
“Parenting, especially mothering, has become an anxious endeavor, characterized by pervasive self-doubt and guilt”
Ara Francis, 2012
Solutions?
So where do we go for solutions? How can we ensure that more women’s experience of motherhood is autonomous and affirming? In terms of childbirth, authors Phelan and O’Connell present midwifery as a promising solution to combat medicalization, but still encourage collaboration between obstetric and midwife teams (Phelan and O’Connell 2015). In Torres’s article on breastfeeding, she emphasizes the role lactation consultants can play in the de-medicalization of breastfeeding, using these providers to examine the concept she describes as “medicalizing to demedicalize” (Torres 2014). And in Francis’s article on stigmatization and “anxious parenting”, she describes parental stigma as a “relational phenomenon” that thrives on the intersection of dominant cultural assumptions and institutions of medical authority (Francis 2012). Taken together, these three authors come to the conclusion that both incremental change and widespread cultural overhaul may be necessary to combat the medicalization of motherhood: we have a lot of work to do before my mother’s story seems mainstream.
In summary,
| Solutions for the Medicalization of Motherhood |
| 1. Interdisciplinary Teams of Providers |
| 2. “Medicalizing to Demedicalize” |
| 3. Challenging Cultural Assumptions |
References
California Health Care Foundation. 2018. “Infographic: The Overmedicalization of Childbirth.” From Listening to Mothers in California survey. https://www.chcf.org/publication/infographic-overmedicalization-childbirth/#related-links-and-downloads
Francis, Ara. 2012. “Stigma in an era of medicalisation and anxious parenting: how proximity and culpability shape middle class parents’ experiences of disgrace.” Sociology of Health and Illness 34, no. 6 (July 2012): 927-942. https://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.2011.01445.x
Johanson, Richard, Mary Newburn, and Alison Macfarlane. “Has the medicalization of childbirth gone too far?” BMJ (Clinical Research ed.) 324, no. 7342 (April 2002): 892-895. https://doi.org/10.1136/bmj.324.7342.892
Phelan, Agnes and Rhona O’Connell. 2015. “Childbirth: Myths and Medicalization.” https://www.euro.who.int/__data/assets/pdf_file/0007/277738/Childbirth_myths-and-medicalization.pdf
Torres, Jennifer M.C. 2014. “Medicalizing to demedicalize: lactation consultants and the (de)medicalization of breastfeeding.” Social Science and Medicine 100 (January 2014): 159-166. https://www.sciencedirect.com/science/article/pii/S027795361300600X
World Health Organization. 2015. “WHO statement of cesarean section rates.” World Health Organization. April 14, 2015. https://www.who.int/publications/i/item/WHO-RHR-15.02