Choices in maternity care: a new normal?

The myth of a modern maternity is sold as the end of a story of progression. Actually, it is a choice in a model of care. Midwifery care still exists in the United States. Furthermore, within physician-attended prenatal, birth, and postpartum maternity care, doctors can vary their personal standards and use of interventions. Additionally, the World Health Organization (WHO) and the American College of Gynecologists and Obstetricians (ACOG) have published standards and goals for each phase of maternity care. The modern maternity care in the United States presently fails to meet WHO’s standards thereby contradicting the progress the myth suggests.

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My work will trace the development of a new network of maternity care at a municipal level, from the 1880’s to 1920, to explore how something that was once a domestic-based midwifery model of care developed into a capitalist adventure, an accepted myth of pathology and progress, and a model of modern obstetric care.

The overlap of men who served in public positions, educational institutions, and as entrepreneurs, many of whom were building an image of Los Angeles as an urban destiny for white racial supremacy, created a level of hegemony that enabled a shift from the preindustrial female health network to institutionalized and commodified care. The new health network influenced an emerging cultural paradigm of reproduction. Changes began happening in some areas quicker than in others, until the current paradigm of reproduction practices became the new normal. Today, 99 percent of births occur in hospitals (a number that has remained steady since 1969), 91 percent of births are attended by doctors, 90 percent of midwife-attended births occur in hospitals, 61 percent of mothers who have vaginal births receive spinal anesthesia or epidural, 33 percent of all births are cesarean (and of course all of these births require pain relief), the rate of induction is more than 22 percent (which is more than double since 1990), and while nearly 75 percent of mothers initiate breastfeeding still more than half wind up feeding their babies infant formula before six months.

The story that follows tells the roots of this paradigm and traces the lineage of these changes. Yet, none of these changes happened without controversy and an undeniable resistance.

from Myths of Modern Maternity: Negotiating Meaning in the Development of Obstetric Culture in Turn-of-the-Twentieth-Century Los Angeles by Jaclyn Ann Mahoney ©2012

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