De l’incertitude de la naissance au risque obstetrical : les enjeux d’une définition

Abstract

La réforme de la périnatalité française, mise en place à la fin des années 1990, repose sur une catégorisation du risque obstétrical (bas, moyen, haut). Selon le niveau de risque estimé, la femme enceinte doit être adressée à une maternité de niveau I, II ou III. À partir d’une enquête effectuée par des observations et des entretiens auprès d’obstétriciens et de sages-femmes, il s’agit, dans cet article, de montrer que la définition de ces catégories du risque est en elle-même un enjeu. En effet, leur contestation ou leur acceptation traduisent deux conceptions sensiblement différentes : l’une induit une accentuation de l’hypermédicalisation de l’accouchement, l’autre tend vers la « dé-technicisation » de la naissance et l’ouverture de Maisons de Naissance, encore à l’état de projet en France.The reform of perinatal care in France, implanted in the late ’90s, is based on a classification of obstetrical risk (low, medium, high). According to her estimated risk level, the pregnant woman will be referred to a I, II or III-level maternity unit. Based on a survey carried out by means of observations and interviews with obstetricians and midwives, the paper sets out to show that the definition of these risk categories is an issue in itself. Indeed, the contestation or acceptance of this classification reveals two very different concepts : the first introduces an accentuation of the hypermedicalization of delivery, the second tends towards its « de-technicalizing » and the opening of Birthing Homes, still at the project stage in France.La reforma de la perinatalidad francesa establecida a finales de los años 90, se basa en una clasificación del riesgo obstétrico (bajo, medio, alto). Según el nivel de riesgo considerado, la mujer embarazada debe ser dirigida a una maternidad de nivel I, II o III. A partir de una investigación efectuada por observaciones y conversaciones acerca de obstetras y comadronas, se trata, en este artículo, de poner de manifiesto que la definición de estas categorías del riesgo es en sí mismo lo que está en juego. En efecto, su conflicto o su aceptación traducen dos concepciones sensiblemente diferentes : una induce un énfasis a dar muchos medicamentos en el momento del parto, y la otra tiende hacia « destecnificar »el nacimiento y la apertura de Casas de Nacimiento, aún, en Francia, en proyecto

‘A caesarean section is like you've never delivered a baby’: a mixed methods study of the experience of childbirth among French women

“…In addition, childbirth in France is governed by high technologization. This technological management of childbirth falls under the culture of ‘obstetric risk’ described above, which is strong in France ( Carricaburu, 2005 , Carricaburu, 2007 ).…”

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

“…Some studies have found these phenomena to be classified by clinicians as innately risky, located along a continuum going from low to high risk (Coxon, Scamell, & Alaszewski, 2012;. As a consequence, this 'lens of risk' (Heyman, 2013;Heyman, Alaszewski, Shaw, & Titterton, 2009) tends to reduce the number of pregnancies and deliveries regarded as 'normal' (Scamell, 2016), or renders births only 'normal' in retrospect (Carricaburu, 2007). Midwives and physicians tend to interpret discrete signs or variations as problematic, which we argue 'casts the future principally in negative, potentially catastrophic terms' (Alaszewski & Burgess, 2007, p. 349).…”

Health regulations and social experiences of ‘high-risk’ pregnancies among young working-class women in Brazil

“…While uncertainty, fear, and the unknown have always been part of the birthing experience, these feelings are currently being rationalised through the category of risk (Carricaburu, 2007;Carricaburu, Castra, & Cohen, 2010). This epidemiological category is also instrumental in organising pregnancy care provision in developing countries like Brazil.…”