A very recent example is the contentious political debate about Obama Care's mandate for all health insurance policies to cover birth control methods. Not only is it jaw-dropping that in this day and age we should even be put in the position to have to defend our right to control our own reproductive health, given the existence of safe technology that aids us in this feat, but even more appalling is the discourse and rhetoric that accompanies this political debate. I can't even write his name on here without feeling nauseated, but really, aren't his remarks offensive and indecent enough to warrant immediate dismissal from his employment??? So why hasn't it happened yet????
Sure, I find his words highly offensive and reprehensible, but another issue that irks me deep down is the fact that in order to raise sympathy for Sandra Fluke and her testimony, which were the object of RL's attacks, the media continuously brings up the fact that birth control is needed by many women to control medical issues related to their reproductive health... why isn't it just as important and valuable to defend a woman''s right to use birth control to prevent her from having an unwanted pregnancy??? Isn't this particular and central function of contraception important in and of itself???? Arrrrggghhhh!!!!
I recently had to articulate my purpose in the field of public health: the reason for which I needed to be engaged in this field for a lifelong career. After several tries at it and multiple revisions, I was finally able to identify the common thread behind "all things public health" that light my fire and drive my passion and mission. My purpose is to influence the maternal and child health field to elevate the role of women and the importance of their health status, independent of their reproductive health choices and capacity. I want my field to recognize and act on the fact that women and their emotional, physical, and social well being are important not just because women may one day become pregnant and have babies, but because women are important in and of themselves regardless of the possible birth outcome they might have.
I value this perspective specifically as it relates to maternal health. I want women to be treated as whole individuals prenatally, intrapartum, and postpartum and not just as baby-carrying vessels as they embark in a very important journey of motherhood. Framing maternity care from this perspective has implications on how maternity care is organized and delivered. Feminist thought has found me, as I started analyzing my own experiences as a woman experiencing maternity care in the U.S. and have started growing deeply disenchanted with the overwhelmingly suboptimal treatment of new mothers in many U.S. health care facilities.Following is an excerpt from a paper I had to write for one of my graduate classes. It ties some of the readings done for this class to the topic of childbirth. I expect to be reflecting on this and other similar issues more and more as my course of study and professional development continue to take me closer to developing my purpose in the field of maternal and child health: stay tuned!
"One of my main areas of interest in public health is the medicalization of childbirth. I have been finding the materials treated in this class as very informative and definitely applicable to this topic of interest. “Medicalization” is defined by Conrad (1992) as “the process by which nonmedical problems become defined and treated as medical problems” (Conrad, 1992), a term that is appropriately applied to the physiological process of birth, which is increasingly perceived as a medical condition being treated and facilitated through intense active labor management practices (Martin, 1987). In Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences by Declercq, Sakala, Corry, Applebaum, and Risher (2002) the authors state that “less than 1% of mothers gave birth without at least one of the following interventions: being attached to an electronic fetal monitor continuously or nearly so throughout labor (93%); being connected to an IV line (85%); having their membranes artificially ruptured (67%); being given artificial oxytocin to start or stimulate labor (63%); having a gloved hand inserted into their uterus after birth (58%); using a catheter to remove urine (41%); getting an episiotomy (35%); and having pubic hair shaved (5%).”
As reviewed in Walsh (2010), there is currently an abundance of conflicting rhetoric surrounding maternity care services and healthy childbirth in the U.S and abroad. Debates entangling conflicting viewpoints surround issues such as the “medicalization” of birth and the generous use of technologies in maternity care settings (Johanson, Newburn, & Macfarlane, 2002; Williams, 2006), as well as the use of labor pain management techniques (Lally, Murtagh, Macphail, & Thompson, 2008; Leap and Anderson, 2008) and the oftentimes conflicting professions of obstetrics and midwifery (Witz, 1992; Donnison, 1988). These debates are further enriched by feminist discourses that analyze these same issues from a woman’s choice and woman’s empowerment standpoint, with authors often finding themselves at odds with each other, as well as at odds with the medical establishment in the context of power differentials and medical patriarchy (Schrom Dye, 1980; Gimenez,1991; Lazarus, 1994; Cahill, 2001; Shaw, 2002; Reiger & Dempsey, 2006; Staton Savage, 2006).
Sullivan (2003), Wilson and Cleary (1995) as well as Hudak et al (2003) present a challenge that medical health care systems have faced for many decades as their practice guidelines, protocols and tools were designed primarily to fit a Cartesian paradigm in which mind and body are treated as separate entities, and the body is seen as a machine to be fixed. This is an issue, which many would argue, is shared in modern obstetrical care. The deeply visceral experience of labor and childbirth is sometimes spoken about in terms of embodiment with the understanding that the bodily experience must be taken in consideration as a whole, including the experience of the emotional mind and the perception of pain (Simkin, 1991). This viewpoint is starkly in contrast with the medical establishment’s propensity to reduce the female body to a sum of physical parts (biological essentialism) and as a flawed machine that needs to be fixed (Davis-Floyd, 2003). It is with this characterization in mind that childbirth moved from an almost exclusively “at home” event to a 99% hospital “procedure”, necessitating the technology, expertise, and increased perceived safety of hospital settings (Corea, 1985).
In keeping with this rationale, medical providers will often refer to the process of labor and childbirth as a process that is subject to mechanical breakdown using expressions such as “failure to progress”, “incompetent cervix”, and “to section” (Garcia, Kirkpatrick, & Richards, 1990; Hunter, 2006). A fourth-year obstetrics resident interviewed by Davis-Floyd (2003) equaled the maternity care process to an assembly-line production of goods: “We shave’em, we prep’em, we hook’em up to the IV and administer sedation. We deliver the baby, it goes to the nursery and the mother goes to her room. There’s no room for niceties around here. We just move’em right on through. It’s hard not to see it like an assembly line.” (Davis-Floyd, 2003, p.55).
Sullivan (2003) raises the issue of informed consent as a powerful tool for patients to take greater ownership of medical care decisions affecting their health and quality of life, even if such ownership translates into the effective decision to “choose death” over life-sustaining treatment. A recent statement made by the American Congress of Obstetricians and Gynecologists (ACOG, 2008) criticizes women who choose to give birth at home, rather than in a hospital, by saying that such informed choice is equivalent to “placing the process of giving birth over the goal of having a healthy baby.” Yet ACOG has yet to find a way to mend its faulty maternity care system, a medical care system that splits the body-mind connection during childbirth and takes complete ownership of the birthing process: a system that is not only inadequate, but can also become highly detrimental.
In a recent study titled New Mothers Speak Out surveying women who had become new mothers in the previous six months, it was found that approximately two out of three (63%) new mothers suffered from varying degrees of depressive symptoms, including “shifting emotions and sleep disturbances (even when the baby was sleeping), […] anxiety, loss of sense of self, and/or mental confusion and guilt.” (Declercq, Sakala, Corry, & Applebaum S, 2008) The same study has been touted as the first research study providing a national estimate of the prevalence of birth-related Post-Traumatic Stress Disorder (PTSD). Whereas historically PTSD has been consistently associated with war and combat experiences, in recent years it has also been linked to other traumatic experiences such as sexual assaults, natural disasters, and road accidents.
More recently childbirth has joined the ranks of recognized events that could be perceived and experienced as traumatic, not only by the mother, but by all those involved in the birthing event ( Soderquist, Wijma, & Wijma, 2002). Using the Post-Traumatic Stress Disorder Symptom Scale (PSS), the study found that 27% of new mothers were experiencing some to all qualifying symptoms of PTSD (18% of mothers experienced some symptoms associated with PTSD, while 9% met all the qualifying PTSD criteria). A British study for which results were published in 2000, found a similar prevalence of PTSD in the United Kingdom, with 3% of women suffering from all criteria of PTSD and 24% showing signs of at least one PTSD dimension (Czarnocka & Slade, 2000). Other studies estimating PTSD incidence found rates between 1.5% and 6% of new mothers (Ayers & Pickering, 2001; Menage, 1993).
Clement (2001) suggests that women who undergo a high number of medical interventions during labor resulting in a surgical delivery, often attribute their cesarean birth to iatrogenic factors and subsequently develop feelings of anger towards their caregivers for facilitating and often pushing upon them interventions that, in their opinion, were not necessary, that created endangering and stressful conditions, all the while without providing sufficient opportunities for involvement in decision making and without providing truly informed consent. Women interviewed by Clement (2001) expressed feelings of violation using words such as “mutilated”, “butchered”, “like a piece of meat”, and “almost raped”. For an event which is “seminally influenced by psychosocial factors” (Walsh, 2010, p. 491) an approach that ignores or minimizes the embodied experience of the woman is a sign of the struggle between a woman’s personal agency and the social structure in which she is embedded (Walsh, 2010).
In contrast with the trend towards elevating the patient’s subjective experience and concern for quality of life (Sullivan 2003; Wilson and Cleary, 1995), morbidities and complications arising from childbirth are often viewed by the modern health care system as primarily related to the physicality of birth, and more specifically to the primary by-product of birth: the healthy perfect baby. Another obstetrician interviewed by Davis-Floyd stated: “It was what we were all trained to always go after – the perfect baby. That’s what we were trained to produce. The quality of the mother’s experience – we rarely thought about that. Everything we did was to get that perfect baby.” (Davis-Floyd, 2003, p. 57) And so with a lack of tort reform in many U.S. states, obstetricians are feeling the pressure to avoid damaging lawsuits connected to “imperfect babies” resulting from a cesarean delivery that was either not performed or performed too late, with resulting defensive practices acting as one important driving force behind the rising cesarean section trends in the US (Birchard, 1999; Fuglenes, Oian, & Kristiansen, 2009; Declercq, 2009, and personal communication with members of the Florida Perinatal Quality Collaborative, 2010).
Recent birth activist movements have been pushing for a more “humanized birth” as a way to improve the woman’s subjective experience of birth even within a highly technocratic environment. While explaining the concept of “humanized birth” Wagner (2001) explains that “respecting the woman as an important and valuable human being and making certain that the woman’s experience while giving birth is fulfilling and empowering is not just a nice extra, it is absolutely essential as it makes the woman strong and therefore makes society strong. Humanized birth means putting the woman giving birth in the center and in control so that she and not the doctors or anyone else makes all the decisions about what will happen.” (Wagner, 2001) This is perhaps akin to what Sullivan and others in the field of health care services research would call patient-centered care."
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