Pregnancy and power: why has childbirth moved from the home to hospitals?

Anthropological perspectives are an interesting lens through which to understand modern experiences of pregnancy and birth. Often, we take for granted the vernacular that surrounds pregnancy, words like ‘labour’, ‘reproduction’ and ‘delivery’ hold undeniable connotations with the industrial machines that fuel our capitalist societies. This demonstrates how something that is intrinsically domestic is influenced by societal power dynamics, and in this article, I will explore the influence that authoritative knowledge has had on this field.

One Anthropological theory that is at the forefront of research in this niche is the theory of bio-power, first discussed by Michel Foucault. Foucauldian perspectives explore the power relationships that are created by language and interactions between people. Bio-power in particular, encompasses the power exerted over the body itself, such as the control of birth rates within a population by the existing authority. Anthropological studies of medical obstetrics in pregnancy often examine these power dynamics, particularly regarding clashes and overlap between traditional or cultural aspects, and scientific or modern approaches to childbearing.

Historically, traditional models of childbearing revolved around the knowledge of midwives, who learned from experience and the generation that came before them. Obstetricians and doctors began to replace midwives in the Enlightenment era, and their knowledge typically came from medical texts. It is within these texts that we begin to see these metaphors that align women’s bodies with machines, reflecting the increased emphasis on efficiency within childbirth.

In a modern context, we typically consider hospital births as a safer option that decreases the risk of complications. This was not always the case however, demonstrated by the findings of Ignaz Semmelweis. During the 1840s Semmelweis worked at Vienna General Hospital and noticed that maternity wards attended by medical students had a far higher death rate from puerperal fever compared to those treated by midwives. He hypothesised that this was down to the students not washing their hands between post-mortem examinations and obstetric examinations. Surprisingly, despite the evidence, this was met with uproar from the medical community, and he fled to Budapest. There he published The Cause, Concept and Prophylaxis of Childbed Fever, which detailed how the disease was spread by the doctors themselves in between examinations, and was eventually influential in creating the hygiene practices seen in hospitals today.

The hospital model which is common in western countries is not universal however, and the form that medicalisation of pregnancy takes varies across the globe. An interesting example of this includes the ethnography written by Van Hollen about pregnant women in South India. At her field site Chennai, Van Hollen was surprised to find a fairly universal desire to increase the pain of childbirth by having an induced pregnancy, vastly different to British hospitals where medicine is there to ease the pain primarily. This stemmed from a cultural belief that the baby would only be born if the pains were strong, leading to a desire for increased pain.

Global models of medicalisation, though they vary, are all influenced by local traditions and culture, as well as existing power structures and authoritative knowledge. This is particularly interesting anthropologically, as it demonstrates just one way our lives are shaped and influenced by bio-power and cultural traditions.

Glossary

Authoritative knowledge - when multiple kinds of legitimate knowledge exist on a subject, one becomes dominant and the other existing ideas are dismissed.

Puerperal Fever - Also known as childbed fever and is a bacterial infection of the reproductive tract following birth or miscarriage.

Sources

Jordan, Brigitte. 1997. ‘Authoritative Knowledge and its Construction’. In Davis-Floyd, Robbie and Sargent, Carolyn (eds.) Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives. Berkeley: University of California Press, pp55-79.

Van Hollen, C. 2003. Invoking vali: painful technologies of modern birth in south India. Medical Anthropology Quarterly, 17(1), 49-77.

Venita Jay; Ignaz Semmelweis and the Conquest of Puerperal Sepsis. Arch Pathol Lab Med 1 July 1999; 123 (7): 561–562.

Image credit: Royal College of Nursing