Pregnancy, labor and body image in the United States

Controlling the unruly maternal body: Losing and gaining control over the body during pregnancy and the postpartum period

This paper examines the feeling of lost control of the body that so many women experience through pregnancy and the postpartum period - why they feel it and how they interpret that feeling - and women's responses to the sense of lost control. For the 63 Canadian women we interviewed, the sense of lost control was related to the degree they felt their bodies changed and the number of physical problems they experienced while pregnant. Many women's references to "luck" as the cause of body changes and problems experienced underscored how little control they felt they had when they were pregnant. At the same time, women felt responsible for the well-being of their babies, and thus experienced guilt about their unruly bodies. Careful attention to diet helped some women, but not others, regain some sense of control; women with past experience of pregnancy who "gave in" to body change were more sanguine. In the postpartum period, body work (especially exercise) functioned to increase women's sense of control, but a variety of motives led them to do this work.

Situated technology in reproductive health care: Do we need a new theory of the subject to promote person-centred care?

Going through reproductive experiences (especially pregnancy and childbirth) in contemporary Western societies almost inevitably involves interaction with medical practitioners and various medical technologies in institutional context. This has important consequences for women as embodied subjects. A critical appraisal of these consequences-coming dominantly from feminist scholarship-relied on a problematic theory of both technology and the subject, which are in contemporary approaches no longer considered as given, coherent and well individualized wholes, but as complex constellations that are locally situated and that can only be described empirically. In this study, we will be relying on the developments in phenomenological theory to reconceptualize women as technologically mediated embodied subjects and on the new paradigms in philosophy of technology and STS to reconstruct medical technology as situated-with the aim of reconceptualizing their relationship and exploring different possibilities for the mediating role of medical technology. It will be argued that technologization of female reproductive processes and alienating consequences for women are not necessary or directly interrelated. The role of technology varies from case to case and depends mainly on the nontechnological and relational aspects of institutional context, in which medical practitioners play a decisive role.

The rhetoric of “natural” in natural childbirth: childbearing women's perspectives on prolonged pregnancy and induction of labour

It is widely known that the notion of prolonged pregnancy, defined medically as 41+ or 42+ weeks gestation, has been hotly debated within the medical and midwifery communities for many decades. Within this debate, pregnant women's voices have rarely been heard. Presented here are the results of a qualitative study of self-care in pregnancy, birth and lactation with a non-random sample of women in British Columbia, Canada. A panel of 27 women was interviewed in the third trimester of pregnancy, and 23 of the same participants were re-interviewed post-partum (50 interviews in total). Interviews were tape-recorded, transcribed, and analyzed thematically. Many of the women said they favoured a natural birth and were opposed to labour induction at the time of the first interview. Yet all but one of the ten women who went beyond 40 weeks gestation used self-help measures to stimulate labour. These women did not perceive prolonged pregnancy as a medical problem per se. Rather they saw it as an inconvenience, a worry to their friends, families and maternity care providers, and a prolongation of physical discomfort. The findings are interpreted by examining the literature on the medicalization/healthicization of childbirth.

Midwifery care and out-of-hospital birth settings: how do they reduce unnecessary cesarean section births?

In studies using matched or adjusted cohorts, U.S. women beginning labor with midwives and/or in out-of-hospital settings have attained cesarean section rates that are considerably lower than similar women using prevailing forms of care--physicians in hospitals. This cesarean reduction involved no compromise in mortality and morbidity outcome measures. Moreover, groups of women at elevated risk for adverse perinatal outcomes have attained excellent outcomes and cesarean rates well below the general population rate with these care arrangements. How do midwives and out-of-hospital birth settings so effectively help women to avoid unnecessary cesareans? This paper explores this question by presenting data from interviews with midwives who work in home settings. The midwives' understanding of and approaches to major medical indications for cesarean birth contrast strikingly with prevailing medical knowledge and practice. From the midwives' perspective, many women receive cesareans due to pseudo-problems, to problems that might easily be prevented, or to problems that might be addressed through less drastic measures. Policy reports addressing the problem of unnecessary cesarean births in the U.S. have failed to highlight the substantial reduction in such births that may be expected to accompany greatly expanded use of midwives and out-of-hospital birth settings. The present study--together with cohort studies documenting such a reduction, studies showing other benefits of such forms of care, and the increasing reluctance of physicians to provide obstetrical services--suggests that childbearing families would realize many benefits from greatly expanded use of midwives and out-of-hospital birth settings.

Medically unnecessary cesarean section births: introduction to a symposium

Between 1965 and 1986, the United States cesarean section rate increased from 4.5 to 24.1%. Increasingly, childbearing women and their advocates, along with many others, have recognized that a large proportion of cesareans confers a broad array of risks without providing any medical benefit. A growing literature examines the diverse causes of medically unnecessary cesareans and the diverse effects of surgical birth on women, infants, and families. Various programs and policies have been proposed or implemented to reduce cesarean rates. In recent decades, many other nations have also experienced a sharply escalating cesarean section rate. It is reasonable to conclude that a largely uncontrolled international pandemic of medically unnecessary cesarean births is occurring. The level of political, analytic, and programmatic activity that has occurred in the U.S. regarding medically unnecessary surgical births does not seem to be paralleled in other nations with sharply escalating rates. This symposium was organized with the objective of presenting the U.S. experience with various dimensions of the problem of medically unnecessary cesareans to an international audience. Although preliminary and inadequate, it is hoped that this experience will encourage policy leaders and investigators throughout the world to recognize and address the problem of run-away cesarean section births. The first section of this introduction summarizes the U.S. experience with medically unnecessary cesareans from the perspective of trends, causes, consequences, and solutions. The second section covers the same topics, presenting selected material from various other nations throughout the world. In the course of these overviews, I introduce the symposium's seven contributions, most of which focus on circumstances in the U.S.