Is't modern childbirth to much medicalized?

1. Dr Kiran Regmi, PhD
regmikirang@gmail.com
Emergence of Respectful Maternity Care
Dr Kiran Regmi
PhD

2. Tackling disrespect and abuse
during facility based childbirth
Emergence of Respectful Maternity Care >
Defining respectful maternity care

3. Emergence of Respectful Maternity Care >
categories of disrespect and abuse

4. Emergence of Respectful Maternity Care >
Defining women in various historical eras
Women have been defined by the ideological
apparatus of the state to suit the patriarchy
Althusser’s (1971) defines ideological state apparatus
as a certain number of realities that present
themselves to the immediate observer in the form of
distinct and specialised institutions
These institutions are religious, educational, familial,
legal, political, and cultural. He thinks that the state
ideologies change with time. As the state ideologies
change, the definition of woman also changes

5. One class structure of women would consist of
an aristocracy, which ruled as a privileged elite.
By and large, they appear as queens, empresses
and consorts of powerful men, or as regents for
sons and grandsons—but occasionally also as
artists, military leaders, political manipulators
and writers.
Another class structure women were restricted in
their roles as the peasantry, which farmed the
land, limited by social status, by economic
constraints.
Emergence of Respectful Maternity Care >
Defining women in various historical eras > Medieval
women

8. Western women appear as wives and writers,
lovers and soldiers, mothers and midwives,
scientists and traders
The popular image of the Asian women continues
to be that of a submissive bride behind her veil, a
reticent daughter-in-law, a devoted mother, and
finally, a ruling mother-in-law.
Women’s right to liberty was restricted in the
name of modesty, protection and prevention of
immoral activity
Emergence of Respectful Maternity Care >
Defining women in various historical eras > Modern women

10.  Sadly, most of the women’s movements fail(ed) to
rescue women in developing countries
 The tragedy with the women’s movements is that
women from the upper classes, who mostly dominate
the women of lower class, have never had to suffer the
same ordeals as the women of the oppressed classes
 The adverse conditions in important areas such as
public hygiene and childbirth have a greater bearing on
women of the working classes
 Hence the struggles for the rights of women, and their
liberation, have different meanings for women of
various classes
Emergence of Respectful Maternity Care > Defining
women in various historical eras > Postmodern women

11. Emergence of Respectful Maternity Care >
Defining women in various historical eras > Nepali women
ERA Situation of Women
Kirati Women were not different from men in their
living style
Licchavi Freedom to property, education, political
rights and marriage
Malla Women's rights varies according to the caste
and class
Thakuri
dynasty
Renaissance for Nepali women
Rana dynasty Gender discrimination was at a peak
Shaha kings Comparatively better than the Rana period

12.  Attention was turned toward the spiritual and supernatural
agencies instead of relying upon observation, experience,
experiment and thought
 The magical beliefs and superstitions prevalent at the time
forced people to believe that an unfavorable childbirth
outcome was largely a punishment from God, and so
confession of sin for some wrongdoing was considered
necessary for healing
 The enclosed childbirth chamber, the presence of female
attendants, and the birthing women’s modesty, were
believed to be important elements of medieval childbirth
customs that helped to maintain a medieval woman’s
spirituality during childbirth
Emergence of Respectful Maternity Care > Defining
childbirth in various historical eras > Medieval childbirth >
principle

14. The birth chamber was sealed—from the
windows to the keyholes—and became a site
of exclusively female activity
It was within this enclosed space where
women usually found the only room of their
own. One could possibly view the enclosed
birth room as an extension of the childbearing
body
Emergence of Respectful Maternity Care > Defining
childbirth in various historical eras > Medieval childbirth >
principle

15.  In the Early Middle, childbirth was an event mediated by
female midwives, who delivered women in their homes
with the comfort and help of female friends and family
 Trotula Major (historical childbirth book), concludes that
female midwives were not only healers, but also the
researchers who discovered a number of useful drugs that
have become popular in maternity care
 They were confidantes and wise advisors to medieval
women.
 Their craft knowledge accumulated over many generations
from the keen study of Nature, and from experiments to
find useful ways to work with Nature
Emergence of Respectful Maternity Care > Defining childbirth
in various historical eras > Medieval childbirth > childbirth assistants

17.  The natural indigenous medicines described in Trotula Major used
in the course of deliveries which include wine, barley water,
vinegar, rose water, honey, butter, gum Arabic, olive oil, flaxseed,
cloves and roses
 The herbs included lady’s mantle to stop bleeding, wormwood to
relieve pain, hops for a calming effect, smut rye to stimulate uterine
contractions, and henbane and poppy for relief from pain
 Other more advanced herbal drugs that the midwives discovered
are ergot, used to stop uterine bleeding, belladonna to regulate
contractions and prevent miscarriages, and digitalis for heart
complaints
 Derivatives from these plants still play a very major role in modern
medicine
 The child was rubbed with salt, and the palate of the gums of the
child was cleansed with honey, to give it an appetite
Emergence of Respectful Maternity Care > Defining childbirth
in various historical eras > Medieval childbirth > Childbirth
medications

18. Olive oil
Honey
Clove

19.  The clothes women wear during labour were of indigenous
style. It consisted of a shift tucked up under the arms with
a short petticoat placed about the hips which was to be
removed after labour and the dry shift drawn down
 The position most commonly used during childbirth was
the Sims position, which entailed lying on the left side of
the body with knees bent and drawn up into the abdomen
 This position prevented the accoucheur (birth attendant)
and the woman from seeing each other, enabling the
mother to save face in an embarrassing situation for
Victorian women
Emergence of Respectful Maternity Care > Defining childbirth
in various historical eras > Medieval childbirth > Childbirth privacy

21. The relationship between the sick person and the
doctor, especially in the cases of women, was
governed strictly by the belief in the need for
patient privacy
 Doctors seldom, if ever, actually examined
female patients, and childbirth procedures were
carried out via a dividing curtain, which
separated the doctor from the mother
The physician was not even allowed to look at
the woman. After the birth, the midwife cut the
umbilical cord at the length of four fingers
Emergence of Respectful Maternity Care > Defining childbirth
in various historical eras > Medieval childbirth > Childbirth privacy

22.  The Renaissance, has its impact in childbirth practices
 Although, historically, female midwives were making
significant contributions to medical advancement, they were
also accused of witchcraft
 The female started losing their control over the maternity
practices to males in the 16th
century with the advance of
anatomical knowledge
 Medieval childbirth practices went through extreme
turbulence
 The instability in childbirth practice of the medieval era
created a ground for the emergence of modern childbirth
practice
Emergence of Respectful Maternity Care > Defining childbirth
in various historical eras > Medieval childbirth > Renaissance

23.  The caesarean section was first reported in England in the 16th
century
 In 19th
century development of obstetrics, which encompasses
all aspects of pregnancy, childbirth and its consequences,
evolved as part of the rise of science and technology
 This moved the care of the mother and the child from the
home and the midwife, to the hospital and the doctor
 Medicalized childbirth has changed the atmosphere
surrounding childbirth from one of a circle of loving support
around labouring women, to one of space-age technology in a
laboratory setting
Emergence of Respectful Maternity Care > Defining childbirth
in various historical eras > Modern childbirth > Medicalization

24.  The birth process become more inhumane, with invasive
rituals such as the shaving of pubic hair, strapping down of
arms and legs, and forcing of enemas, and other equally
frightening and potentially more dangerous procedures took
their place. Childbirth interventions multiplied, creating a new
norm, a new measure of reality making a comeback
 These changes encompassed a ‘battle of the sexes’ as male
physician’s control over the childbirth process from female
midwives
 Some male doctors saw traditional women healers their
commercial rivals. The traditional women healers’ knowledge
about cheap local herb-based medication and their own
unique approach to birthing women and their family
threatened the male doctors
Emergence of Respectful Maternity Care > Defining childbirth
in various historical eras > Modern childbirth > Medicalization

26.  The development of medicine as a science, the emergence of
obstetrics, and the shift from home to hospital as the usual
place of parturition, all contributed to an increasing
medicalization of childbirth
 While these strategies were seen to be successful in
improving the safety of childbirth, many believed they were
also responsible for the disintegration of women’s sense of
dignity, fulfilment and autonomy during the birthing
experience
 The consensus was a good childbirth experience should be
happy and gratifying, as well as safe. For this they started to
demand an active role in the birth of their babies. This marks
the hallmark of post-modern thought
Emergence of Respectful Maternity Care > Defining childbirth
in various historical eras > Modern childbirth > Medicalization

27. Post-modernists felt the need to make
corrections to the domination of science and
technology in what is essentially a natural
process
The introduction of advanced technologies is not
only viewed as a change in childbirth practices,
but also as a matter for debate
There should be some technique that approaches
childbirth from a woman’s perspective. The
mother’s maternal strength and powers need to
be recognized and enhanced
Emergence of Respectful Maternity Care > Defining childbirth
in various historical eras > Postmodern childbirth > Towards nature

29. By looking at these changes, one can see the
evolution of childbirth practice as it developed
from simply a home affair to a techno-
dominated field, and how it is now beginning
to break away from some of the technocratic
medical methods that have been used for
over fifty years
Emergence of Respectful Maternity Care > Defining childbirth
in various historical eras > Postmodern childbirth > Towards nature

30. Conclusion
“And when Lotus had gone to her room he thought to
himself, ‘I did not fear like this when O-Lan bore her first,
my son’, And he remembered that day. And how she had
gone alone into the small dark room. And, how alone, she
had borne him sons and daughters, and borne them
silently. And she had come out to the fields and worked
beside him again. Yet here was this one, now, the wife of
his son, who cried like a child with her pains, and who had
all the slaves running about the house and her husband by
her door. And he remembered, as one remembers a dream
long past, how O-Lan rested from her work and fed the
child, sitting on the ground in the sunshine. And this
seemed too long ago ever to have happened”. (The good
earth, Buck 1963: 112)