Technology, Science, and Obstetric Practice: The Origins and Transformation of Cephalopelvimetry

Abstract

The process of technological change in obstetrics must be understood as contingent on the exigencies of the professional project, rather than in terms simply of improvement or dehumanization of care. Transformation in the procedures by which the female pelvis and the fetal head have been measured illustrate this point. The development of new measurement techniques was profoundly influenced by the shifting locus of obstetric care and by changing professional concerns, including the initial demarcation of a professional practice and subsequent debates about preferred modes of intervention .Prior to the seventeenth century, processes of pregnancy and childbirth were almost exclusively the concern of women. The major role in the delivery was played by the mother herself, assisted by a midwife, almost certainly a woman. In the course of the seventeenth century, the practice of midwifery began to be regulated in many European countries, and educational requirements were imposed. Teaching, largely in anatomy and examination of candidate-midwives were made the responsibility of university-educated doctors. Through the seventeenth and eighteenth centuries the authority of (male) doctors in this traditionally female world grew. Doctors had the advantage of access to instruments with which they claimed they could bring difficult deliveries to successful conclusion. Midwives were often denied use of these instruments. Obstetrics was introduced into the university education of physicians, although normal deliveries remained the prime responsibility of midwives.Today pregnancy and delivery have largely become a matter for (mostly male) doctors, deploying a wide range of sophisticated technologies. Moreover, in modern obstetrics the fetus has become a patient in its own right -

“Technological Change and Professional Control in the Professoriate”

“…A well-established theoretic precedent illustrates the importance of analyzing workers’ perceptions of technology to understanding implications for work, beginning at least with Simon’s (1965) encouragement for organizational scholars to understand technology in organizations symbolically. Indeed, research demonstrates that professional workers’ beliefs about their work are a central contingency in the process of technological change (Hiddinga and Plume 1992; Perrin 1998; Novek 2002). As Hiddinga and Plume (1992) indicate, the implementation of any technology entails a process of asking how much more effective a new technique is.…”

“…Indeed, research demonstrates that professional workers’ beliefs about their work are a central contingency in the process of technological change (Hiddinga and Plume 1992; Perrin 1998; Novek 2002). As Hiddinga and Plume (1992) indicate, the implementation of any technology entails a process of asking how much more effective a new technique is. If new technologies contribute to the erosion of professional control, a key indicator of this potential would be that professors perceive them as illegitimate or ineffective, as implementation under these circumstances would be indicative of the loss of control over conditions of work.…”

On value-judgements and ethics in health technology assessment

“…Technology constitutes what we conceive of as disease (Hofmann 2001b), and thereby is self-augmentative. There seems to be a pathological reliance on technology (Hiddinga and Blume 1992), as technology has become the bias of our culture (Wolf and Berle 1981;Hanson 1999;Kim et al 2001).…”

Is There a Technological Imperative in Health Care?

“…Life is to be saved, regardless of the quality of the life that is saved (2;23, 870). It has also been argued that technology contributes to respect for moral principles; for example, in obstetrics the fetus has become a patient in its own right due to modern technology (20).…”

“…Moreover, it is claimed that there is an excessive inquisitiveness about technology, and that physicians appear to be wedded to technology (23). There seems to be a pathological reliance on technology (20,155), as technology has become the bias of our culture (19,13).…”