A qualitative study of 30 women in Scotland, who elected to have a home birth, pointed out that basic choices such as environment, whom is present and how they are cared for, are lacking (Edwards, 2001). In Edwards’ study, she alludes to the hegemonous system which alienates women who want to choose and make their own decisions because of a lack of information, support, conflict in ideology and difficulty being assertive in an unsympathetic environment.
It appears that ‘choice’ in child birth is uncommon; “only in rare circumstances can a woman act and behave exactly as she wishes during the birth process” (Trevathan, 1997:80), which even in western society is dependent on their class and race as well as other cultural factors. Feminists, such as Oakley (1980), believe that in cases where the level of choice and control are largely taken from women they are most likely to feel a sense of ‘hopelessness’, which in some cases leads to clinical depression.
There appears to have been a shift in responsibility, allowing parents in contemporary society to have more say in how their child is born. However, whilst having a child in hospital, the medical professionals still have the final say in cases deemed unsafe for mother and baby. This would override her own agency in the matter, creating the illusion of choice which is, in fact, coercive (Romalis, 1985). Subtle changes in the health acts have been changed accordingly to suit the ideal of choices being accepted as long as they are deemed ‘appropriate’. In the National Health Service Acts of 1946, 1949 and 1968 it states women have the right to a home birth. However, the 1977 National Health Service Act states only that:
Section 3 (1): It is the Secretary of State’s duty to provide throughout England and Wales, to such extent as he considers necessary to meet all reasonable requirements:
d) Such facilities for the care of expectant and nursing mothers and young children as he considers are appropriate as part of the health service. (legislation.gov.uk)
Within Edwards’ study, the idea of it being unlawful to have a ‘lay’ unqualified person to act as a midwife in times of birth created outrage in the participants. In their view this further restricted plans to have a more natural, unmedicalised birth (Edwards, 2001).
There are further sociological approaches to childbirth within hospitals, which vary depending on time period and geographical location. The women in Edwards’ study describe how there is a lack of options when looking at the available space, criticising the setting as being too clinical and ‘plastic’. Additionally, the overwhelming sense of routine procedures, which appeared to be requirements, were often unnecessary and painful (Edwards, 2001). Sally Macintyre (1977) distinguishes four main types of childbirth, according to their sociological approaches:
1. Historical/ Professional – the practitioners of childbirth are viewed in an historical context with reference to a sociology of science /professionals and social policy.
2. Anthropology – the relationship between managing childbirth and cultural belief systems.
3. Patient- orientated – looking at the perspectives of the users of maternity services.
4. Patient- Services Interaction – these combine both professional and the patients’ views and observes the interaction between the two.
Oakley (1980) explains that following Macintyre’s work on these approaches, there were continued efforts to combine them in the 1980s. Versluysen’s analysis (1977) posits that since the mid eighteenth century, the growth in hospital midwifery is capitalised on by male midwives and professionals to gain dominance over their female colleagues. The effect has left the control of care to professionals, rather than the pregnant and labouring women. Furthermore, working-class women were the majority of maternity patients in Britain during the eighteenth and nineteenth century; this facilitated a hierarchal sense of control and allowed middle-class men to control women’s childbirth experience and generally their reproductive organs (Versluysen, 1977).
In relation to Illich’s theory of medicalisation (1976), Edwards goes on to describe how the idea of home birth demonstrates a “…risk discourse” which “…reflects a medicalised rather than a social/midwifery view of birth” (Edwards, 2001 in Kirkham, 2004: 6). As Illich suggests, pregnancy, like old age or the menopause, “…often graduates from one specialist to the next. The public acceptance of iatrogenic labelling multiplies patients faster than either doctors or drugs can medicalise them” (Illich, 1976: 47). This results in poorer societies struggling to keep up with demand for improved health services and the access to alternative medical processes.
Postnatal care directly after labour requires hours or sometimes several days in hospital under medical supervision. Following an ethnographic study in maternity units, Dykes (2004) explored the organisational culture between midwives and the women they were there to support. Dykes reported the midwives seemed stressed and under pressure from over population on the wards, they expressed they didn’t have time to spend with women and couldn’t provide support in regards to breast feeding. The shift length and rota also seemed ineffectual at providing adequate rest or work life balance for the staff (Dykes, 2004). As a result, the pregnant women in labour and in postnatal care were “…reluctant to ask for help” and felt their needs were “trivial” (Dykes, 2004 in Hunter and Deery, 2009: 94); this resulted in women’s emotional and practical needs for support being largely unmet.
Following the case study of Edwards (2001), it highlights the difficulty made for women when trying to have autonomy in making their own decisions in childbirth. Feminists critique the medicalisation model of childbirth as heavily hegemonic, with male professionals often dominating women’s choices. The model Illich puts forth is evident when researching childbirth as an over medicalised event in a woman’s life, the freedom to make their own choices is often made difficult with lack of support or understanding. Interestingly, postnatal care is largely neglected with many women receiving poor support and help with their new-borns.
Dykes, F. (2009) ‘No Time to Care’: Midwifery Work on Postnatal Wards in England’. In Hunter, B. and Deery, R. (eds). Emotions in Midwifery and Reproduction. (pp. 90-104). Hampshire: Palgrave Macmillan.
Edwards, N.P. (2001) ‘Why Can’t Women Just Say No? And Does It Really Matter?’ In Kirkham, M. (ed), Informed Choice in Maternity. (pp. 1-29). Hampshire: Palgrave Macmillan.
Macintyre, S. (1977) ‘The Management of Childbirth: A Review of Sociological Research Issues’ Social Science and Medicine. (11) pp 477-84.
National Health Service Act. (1977) [Online] Available at: http://www.legislation.gov.uk/ukpga/1977/49/pdfs/ukpga_19770049_en.pdf. Accessed on 10th May 2017.
Oakley, A. (1980) Women Confined. Oxford: Martin Robertson and Company Ltd.
Romalis, S. (1985) ‘Struggle between Providers and Recipients: The Case of Birth Practices.’ In Lewin. E and Olesen. V (eds), Women, Health and Healing: Toward a New Perspective. (pp.174-208). London: Tavistock.
Trevathan, W. (1997) An Evolutionary Perspective on Authoritative Knowledge About Birth. In Davis Floyd, R.E and Sargent , C.F. (eds) Childbirth and Authoritative Knowledge: Cross Cultural Perspectives (pp. 80-88). London: University of California Press.
Versluyen, M. (1977) ‘Medical Professionalism and Maternity Hospitals in Eighteenth Century London: A Sociological Interpretation ‘. The Society for Social History of Medicine. (21) (pp. 34-36).