Artificially maintained scientific controversies, the construction of maternal choice and caesarean section rates

Ignoring international alerts? The routinization of episiotomy in France in the 1980s and 1990s

As scientific evidence from the UK and the USA in the 1980s was questioning the usefulness of episiotomy, the rate in France increased from 38% in 1981 to 58.4% in 1996. In 1996, the World Health Organization recommended limiting the episiotomy rate to 10%. This article aims to examine this paradox through an analysis of the French medical debate on episiotomy during the 1980s and 1990s. Drawing on an analytical corpus composed of 192 articles published in French professional journals of obstetrician-gynaecologists and midwives, it shows that the majority of these health professionals considered episiotomy to be a preventive intervention. The most influential professional organizations and experts manage to refute most of the international alerts on the limitations and side effects of episiotomy through the constant production of new justifications and competing knowledge for the procedure. In the 1980s, episiotomy was seen as a means to prevent tearing and thus avoid perineal dysfunction. Episiotomy and perineal re-education (which developed into a new health sector) were put forward as 'the' solution to the problem. From the mid-1990s onwards, the focus shifted from the mother to the baby as episiotomy was promoted as a way to reduce the risk of newborn mortality and morbidity. This article shows that the alerts and controversies on the assumed iatrogenic effects of biomedical technologies and practices were silenced through efficient and dynamic production of competing knowledge about their assumed benefits.

Giving birth: A hermeneutic study of the expectations and experiences of healthy primigravid women in Switzerland

Switzerland experiences one of the highest caesarean section rates in Europe but it is unclear why and when the decision is made to perform a caesarean section. Many studies have examined from a medical and physiological point of view, but research from a women's standpoint is lacking. Our aim was to develop a model of the emerging expectations of giving birth and the subsequent experiences of healthy primigravid women, across four cantons in Switzerland. This longitudinal study included 30 primigravidae from the German speaking, 14 from the French speaking and 14 from the Italian speaking cantons who were purposively selected. Data were collected by semi-structured interviews taking place around 22 and 36 weeks of pregnancy and six weeks and six months postnatally. Following Gadamer's hermeneutic, which in this study comprised 5 stages, a model was developed. Four major themes emerged: Decisions, Care, Influences and Emotions. Their meandering paths and evolution demonstrate the complexity of the expectations and experiences of women becoming mothers. In this study, women's narrated mode of birth expectations did not foretell how they gave birth and their lived experiences. A hermeneutic discontinuity arises at the 6 week postnatal interview mark. This temporary gap illustrates the bridge between women's expectations of birth and their actual lived experiences, highlighting the importance of informed consent, parent education and ensuring women have a positive birth and immediate postnatal experiences. Other factors than women's preferences should be considered to explain the increasing caesarean section rates.

Mapping Maternal Health in the New Media Environment: A Scientometric Analysis

BACKGROUND

The new media provides a convenient platform to access, use and exchange health information. And as a special group of health care, maternal health care is still of international concern due to their high mortality rate. Scientific research is a good way to provide advice on how to improve maternal health through stringent reasoning and accurate data. However, the dramatic increase of publications, the diversity of themes, and the dispersion of researchers may reduce the quality of information and increase the difficulty of selection. Thus, this study aims to analyze the research progress on maternal health under the global new media environment, exploring the current research hotspots and frontiers.

METHODS

A scientometric analysis was carried out by CiteSpace5.7.R1. In total, 2270 articles have been further analyzed to explore top countries and institutions, potential articles, research frontiers, and hotspots.

RESULTS

The publications ascended markedly, from 29 in 2008 to 472 publications by 2020. But there is still a lot of room to grow, and the growth rate does not conform to the Price's Law. Research centers concentrated in Latin America, such as the University of Toronto and the University of California. The work of Larsson M, Lagan BM and Tiedje L had high potential influence. Most of the research subjects were maternal and newborn babies, and the research frontiers were distributed in health education and psychological problems. Maternal mental health, nutrition, weight, production technology, and equipment were seemingly hotspots.

CONCLUSION

The new media has almost brought a new era for maternal health, mainly characterized by psychological qualities, healthy and reasonable physical conditions and advanced technology.

Adopting an 'unlearner' technology? Knowledge battles over pharmaceutical pain relief in childbirth in post-1968 France

With a national rate of 82.4%, France is currently one of the world's leading users of epidural analgesia (EA), which is promoted not just as a pain reliever but also as a technology that makes childbirth safer. Drawing on analytical tools from science and technology studies, reproductive studies and ignorance studies, I will show how this obstetric drug came to be widely used after significant knowledge/ignorance battles had been fought during heated public and medical controversy in the 1970s. Different visions of the 'knowns', the 'unknowns' and 'know-how' came into conflict in this context, supported by a series of moral, political and feminist justifications that were often at odds with one another. While the defenders of natural birth clashed with feminists, created ambiguities around conceptions of the maternal body, and struggled to produce large-scale clinical knowledge on the risks of EA, the defenders of EA put forward technological promises and biomedical modernization as a means to outstrip the knowledge wars. In the aftermath of this epistemic battle, EA was to gradually become an 'unlearner' technology; that is, a modern tool that radically silenced the maternal body and led to denial, disregard or unawareness of a whole range of shared and alternative knowledges and 'know-how' relating to female physiology and the birth process that are free of pharmaceutical products and medical interventions.

Cesarean sections, perfecting the technique and standardizing the practice: an analysis of the book Obstetrícia, by Jorge de Rezende

This article discusses the development of techniques for cesarean sections by doctors in Brazil, during the 20th century, by analyzing the title "Operação Cesárea" (Cesarean Section), of three editions of the textbookObstetrícia, by Jorge de Rezende. His prominence as an author in obstetrics and his particular style of working, created the groundwork for the normalization of the practice of cesarean sections. The networks of meaning practiced within this scientific community included a "provision for feeling and for action" (Fleck) which established the C-section as a "normal" delivery: showing standards that exclude unpredictability, chaos, and dangers associated with the physiology of childbirth, meeting the demand for control, discipline and safety, qualities associated with practices, techniques and technologies of biomedicine.