‘Knowledge is power’: risk and the moral responsibilities of the expectant mother at the turn of the twentieth century

Hallgrímsdóttir, Helga Kristín; Benner, Bryan Eric

doi:10.4324/9781315266077-3

Cited by 8 publications

(12 citation statements)

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“…In contexts where risk discourses are relatively absent however, such as the case in Jordan, surveillance and interventionism on women's and foetuses' bodies may still be present. By adopting a historical perspective, other researchers have participated in relativising the allegedly new conception of the dangerous and unstable female body entailed by notions of risk (Hallgrimsdottir & Benner, 2014). Another important finding of our paper is to emphasize that forms of social control are exercised on pregnant women's bodies even in contexts where a foetus is not described as 'precious cargo' (Lupton, 2012b).…”

Section: Discussionmentioning

confidence: 89%

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

Maffi

Gouilhers

2019

Health, Risk & Society

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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.

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Section: Discussionmentioning

confidence: 89%

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

Maffi

Gouilhers

2019

Health, Risk & Society

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“…Risk-based medical practice operates through, and in conjunction with, surveillance medicine. Surveillance medicine refers to the increasing use of diagnostic technology, as well as epidemiological and statistical models to create probabilistic models of health risks [41] ; at the same time, surveillance medicine has contributed to an ontological shift whereby categorical understandings of health and illness (i.e., being healthy is mutually exclusive from being ill) to a more ordinal, or scaled understanding, that frames healthy populations from the perspective of their potential for illness [42] . Surveillance medicine thus problematizes normal health as a status of “low-risk” that requires constant monitoring and self-discipline (responsibilization) in order to maintain itself.…”

Section: Surveillance Medicine Risk and Responsibilizationmentioning

confidence: 99%

“…In the 19 th and early 20 th centuries risk was understood primarily in terms of moral and psychological risks, but was also coloured by conceptions of the lack of personhood of the fetus. In other words, risk was understood predominantly in terms of dangers to the pregnant woman; to the extent that these risks were transferred onto the fetus, this occurred because the fetus was transparent to the mother's physical, emotional, and moral health [42] . Today, advancing maternal age, falling birth rates, and the increasing relevance of fetal personhood in legal and cultural understandings of pregnancy (driven as well by improvements in diagnostic and fetal imaging technologies) have contributed to an environment in which the health of the fetus is seen as paramount and independent of the mother's health, and in which competing claims to personhood of the pregnant woman and the fetus are also part of the landscape of risk [42] – [45] .…”

Section: Surveillance Medicine Risk and Responsibilizationmentioning

confidence: 99%

Fear, Risk, and the Responsible Choice: Risk Narratives and Lowering the Rate of Caesarean Sections in High-income Countries

et al. 2017

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In Canada, as elsewhere in the world, caesarean sections are the most common surgical procedure performed in hospitals annually. Recent national statistics indicate 28% of infants in Canada are born by c-section while in the United States that number rises to 33%. This is despite World Health Organization recommendations that at a population level only 10–15% of births warrant this form of medical intervention. This trend has become cause for concern in recent decades due to the short and long-term health risks to pregnant women and infants, as well as the financial burden it places on public health care systems. Others warn this trend may result in a collective loss of cultural knowledge of a normal physiological process and, in the process, establish a new “normal” childbirth. Despite a range of interventions to curb c-section rates—enhanced prenatal care and innovation in pregnancy monitoring, change in hospital level policies, procedures and protocols, as well as public education campaigns—they remain stubbornly resistant to stabilization, let alone, reduction in high-income countries. We explore—through a review of the academic and grey literature—the role of cultural and social narratives around risk, and the responsibilization of the pregnant woman and the medical practitioner in creating this kind of resistance to intervention today.

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“…Z. T. folgt ein Teufelskreis von weiteren Untersuchungen und Sorgen, der auch schädliche Auswirkungen auf die Mutter-Kind-Bindung nimmt und sich nach der Geburt des Kindes fortsetzen kann [25,39,50]. Hallgrimsdottir [51] weist in diesem Zusammenhang darauf hin, dass es für die Risikoschwangere möglicherweise schwierig ist, eine normal verlaufende Schwangerschaft von einem pathologischen Verlauf zu unterscheiden. Um sich sicher zu fühlen, vertrauen einige Frauen auf die Zufriedenheit mit sich und ihrem Körper und auf ihre eigene Kraft, andere Frauen hingegen vertrauen stark auf die Medizin und die Expertinnen [52].…”

Section: Diskussionunclassified

Mutterschaft ab 35 Jahren: Das Altersrisiko in der Wahrnehmung von Frauen – eine Literaturstudie

Niessen

Werner-Bierwisch

Metzing

et al. 2017

Z Geburtshilfe Neonatol

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Delaying motherhood is an ongoing trend in industrialized countries worldwide. The higher the mother´s age, the greater the risks for fertility, pregnancy, childbearing, and for the newborn. The psychosocial situation of women who are conscious of pregnancy risks is thus negatively affected. This paper aims to answer the question as to how women experience the risks of age. An systematic search of the international literature was carried out between December 2015 and March 2016, using the electronic databases PubMed, CINAHL, PsycINFO, Sowiport, as well as a manual search. The inclusion criterion was the perception of reproductive age risks of motherhood at an advanced age, defined as ≥ 35 years. Eleven studies with different designs were evaluated. The participants were sufficiently informed about decreasing fertility rates and the increasing risk of trisomy 21, but less knowledge was shown about the remaining age-associated risks. The awareness of these risks made women feel anxious and scared. They showed various strategies for dealing with their concern: information management, associated with problems of overand misinformation and, in contrast, information avoidance. Other strategies were distraction from thinking about the risks, the need for control and good preparation, or emotional distancing from the pregnancy. The women´s personal risk assessment was complex. They related their social circumstances and their lifestyle and thought about the medical attributions in relative terms. By focusing on giving birth to a healthy child, the mothers often neglected to prepare themselves for living with the newborn. Postpartum they were overwhelmed by the care needed by the newborn child. The age risk cannot be assessed adequately by those affected. Various phenomena determined through risk research may also appear. There was a meaningful difference between the medically assessed risk and the women's perceived risk. Taking the women´s experience with ageassociated risks and the consequences of motherhood into consideration, it seems necessary to discuss the concept of age risk. Healthcare professionals should focus on health support and encourage older pregnant women to familiarize themselves with family-orientated care of a newborn family member.

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‘Knowledge is power’: risk and the moral responsibilities of the expectant mother at the turn of the twentieth century

Cited by 8 publications

References 0 publications

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

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

Fear, Risk, and the Responsible Choice: Risk Narratives and Lowering the Rate of Caesarean Sections in High-income Countries

Mutterschaft ab 35 Jahren: Das Altersrisiko in der Wahrnehmung von Frauen – eine Literaturstudie

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