Conceiving of risk in childbirth: obstetric discourses, medical management and cultural expectations in Switzerland and Jordan

Abstract

In highly industrialised societies, risk shapes representations and practices surrounding childbirth. However, few studies examine the impact of the transnational diffusion of risk in medium and low income societies, where, despite the adoption of biomedical protocols on an institutional level, women and birth attendants often seem to follow different rationales in their practices. In this article, we are interested in the various components of the notion of risk, which shall be understood and examined in relation to specific socioeconomic , political and cultural configurations. Drawing on two ethnographic studies conducted, respectively, in a Swiss university hospital and in three Jordanian government hospitals, we investigate how surveillance and medical interventions are deployed in pregnancy and childbirth in unequally structured health systems and describe negotiations and appropriations surrounding this management. These two contrasting cultural, socioeconomic and health 'system' contexts reveal important differences in the way birth attendants and women consider the notion of risk in childbirth in that it is seldom present in clinicians' and women's discourses and practices in Jordan, whereas it plays a pertinent role in Switzerland. We argue that the heterogeneous configurations of risk mobilised by the participants in these studies reveal that dissimilar histories in terms of medical institutions and health care service provisions, political regimes, economic conditions, and social configurations shape the cultural and techno-medical arrangements of the institutions we studied. Comparing our Jordanian and Swiss ethnographies, we show that the mobilisation of biomedical risk does not happen in a vacuum but rather intertwines with specific social arrangements, eliciting resistance and adaptation that fashion the discourses and behaviours of birth attendants and pregnant women.

The impact of technology on pregnancy and childbirth: creating and managing obstetrical risk in different cultural and socio-economic contexts

“…However, the adoption, reappropriation or adaptation of the risk philosophy and risk governance tools in different national-cultural settings, as a technology for managing childbirth, seem to depend on many parameters that go beyond the simple consideration according to which medically and technologically unattended childbirth is risky. The comparative analysis of the Swiss and the Jordanian cases conducted by Maffi and Gouilhers (2019) provides interesting insights into these processes.…”

“…In comparison, in 'emerging' economies like Turkey and Brazil, recourse to technology, especially to C-sections, have been routinised, thanks to a medical discourse that reframed vaginal birth as both very risky and too painful (McCallum, 2005;Topçu, 2019). In Jordan too, where hospital birth is the norm and where obstetricians play an important role in childbirth, such a risk discourse could have been influential and could have made childbirth as « technocratic » (Davis-Floyd & Sargent, 1997) as in Turkey or China, but this does not seem to be the case, at least until the last decade (Maffi & Gouilhers, 2019).…”

“…Far from a purely western concept, risk can and does diffuse beyond the 'global North' and, moreover, this occurs in heterogeneous ways. Therefore, as Maffi and Gouilhers (2019) put, instead of assuming a global diffusion of the risk paradigm, it is necessary to pay attention to how specific technological, medical, economic and cultural settings facilitate or impede risk colonisation.…”

Comprendre le parcours du devenir parent. Regard sur une démarche de recherche collaborative et qualitative à l’international

“…Se référant à la notion de risque dans une perspective socioculturelle (Burton-Jeangros, 2004;Douglas, 2005), d'autres auteures s'intéressant à la naissance considèrent que le risque n'est pas une donnée objective, mais une construction de la réalité à partir d'une vision du monde, de valeurs et de contextes particuliers (Maffi & Gouilhers, 2019). Ainsi, pour des couples de classe moyenne, un lieu de naissance démédicalisé, voire le domicile, est l'endroit le plus sécuritaire pour vivre un accouchement, évitant ainsi les cascades d'interventions (Rossignol, Moutquin, & Boughrassa, 2012) et les risques iatrogènes d'un accouchement à l'hôpital.…”

“…Les études récentes dans ce champ réfèrent à ces deux systèmes de naissance, à leurs interrelations et tensions dans les représentations et les pratiques; elles pointent par ce fait même les enjeux sociaux et politiques de l'encadrement de la naissance aujourd'hui (Lemay,VOLUME 7 • NUMÉRO 1 • Hiver 2020 2017). En effet, des ethnographies récentes (Faya-Robles, 2019;Maffi & Gouilhers, 2019) dans différents pays et contextes font ressortir que les pratiques entourant la naissance sont étroitement liées aux milieux socio-économiques et aux contextes institutionnels. Déjà plusieurs études nord-américaines et françaises (Davis-Floyd, 2001;Quéniart, 1988;Thomas, 2016) rapportaient que les mères, et de plus en plus souvent les couples (Legros-Jacques, 2018), tendent à « bricoler » leurs choix de naissance en prenant ce qui leur convient (en matière de technologie, de lieu et d'accompagnement) pour satisfaire leurs besoins de sécurité, de confort et d'intimité (Champagne, 2017).…”