Risking birth: culture, technology and politics in 21st century maternity care

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  • Risking birth: culture, technology and politics in 21st century maternity care

The field of childbirth is increasingly contentious in Australia with media reports of escalating staff shortages and conflicts over philosophy of management, service delivery and professional care providers. This workshop brings together a multidisciplinary group to address the ‘politics of maternity care’ by drawing on contemporary social theory and research in order to clarify practical and policy problems. Many governmental enquiries, subsequent recommendations and policy proposals have sought to decrease technological intervention in the physiological processes of pregnancy and childbirth (eg Commonwealth of Australia, 1999; New South Wales Health 2000; Victoria 2004), but ‘medicalised birth’ still dominates the mainstream health system. Indeed, it can be argued, it is actively sought by an increasing population of women and families. For example, the recent publication by the Australian Institute of Health and Welfare (Laws and Sullivan, 2004) disclosed that caesarean sections (CS) have increased from 18% in 1992 to 25.4% in 2004, with even higher rates in the private sector (Roberts et al 2000). Some predict that in a few years the majority of babies will be born by surgery.

Social scientists have established a strong critique of the medicalisation of birth as well as the growth and impact of consumerism. This project seeks to extend this by examining the pervasive cultural construction of reproduction as a medical event laden with risk which is in need of technological management. It juxtaposes policy and professional debates about ‘risk management’ with social theoretical analysis of what, following Ulrich Beck can be termed ‘Risk Society’ (Beck 1992). Beck points to the ways in which environmental, economic and health dilemmas are becoming permanent backgrounds to our everyday life in advanced industrialization. The choice and flexibility claimed to characterise risk culture present new dilemmas for childbearing women and their partners. They now face a myriad of decisions concerning testing and the self-management of a pregnant and lactating body. Both caregivers and parents have to deal with new and highly contested forms of knowledge, new responsibilities and anxieties. Access to information and effective decision-making varies however according to social and geographic location. Furthermore, options remain constrained by a maternity care system in which powerful interests promote drugs and technology as the basis of childbirth management and alternative models of care are resisted as unsafe and ‘risky’. A series of questions will therefore shape the exploration of the relevance of the ‘risk society’ analysis to childbirth:

  1. Theoretical questions:
    • How can we best understand the social and cultural factors shaping the construction of childbirth in Australia in the early 21st century?
    • Do technology and fear of litigation shape perception of ‘risk’ and in whose interests?
    • What role do new reproductive technologies (such as prenatal screening and testing) play in the construction of risk for the pregnant woman?
    • How do women from diverse backgrounds negotiate culturally prescribed health practices and manage pregnancy and birth?
    • Has the neoconservative political climate of individualism affected the culture of birthing?
  2. Policy and practice issues:
    • What has been the impact of neoliberalism on maternity service provision?
    • What problems are midwifery-led models of care facing?
    • Do acute staff shortages undermine the possibility of changing the dominant medical model or do they also present new opportunities?
    • What strategies can ease the tensions between the conflicting cultures of technocratic and holistic maternity care?
    • How can inter- and intra- professional tensions be diminished?
    • How can the participation of women be institutionalised in the new models of care?

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Academy of the Social Sciences in Australia

    ABN: 59 957 839 703
  • Location: 26 Balmain Crescent, Acton, ACT 2601
  • Postal: GPO Box 1956, Canberra, ACT 2601
  • +61 .2 62491788
  • +61 .2 62474335
  • secretariat@assa.edu.au

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