Abstract
Much of the current obstetrical controversy revolves around the word ‘unnecessary’. A growing number of obstetrical personnel genuinely believe that routine medical ‘management’ of labour is in fact necessary, in order to ensure the best outcome for mother and child. (Elkins, 1983, p. 53)
The details of obstetric practices may change in response to societal pressures. What shows no sign of changing is a deep consensus, shared by all of us, that, at least for us, the justification for any way of doing birth must include as its most fundamental concern the issue of medical safety for mother and child. In other societies, other considerations may be more important. Even in our own there was a time when the most salient concern was not with life and death, but with the status of the unborn child’s soul. (Jordan, 1980, p. 88)
In recent years there has been considerable discussion and criticism of the way in which childbirth is handled in modern Western society. The debate has focused on a broad range of issues connected with the ‘medicalisation of childbirth’, such as the displacement of midwives by male obstetricians, home and hospital confinements, the increasingly active medical management of birth, the value of mortality statistics, and the relevance of current research on the importance of early bonding. Debates about some of these trends are beginning to take place also in Czechoslovakia.
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NOTES
The Dutch system of maternity care is positively evaluated in the more professional literature — see, for example, Sradek’s (1981) report on new international developments in obstetrics, published in Ceskoslovenskk gynekologie.
The survey was conducted in Zvolen, a small town in central Slovakia, in 1979. The sample consisted of 332 men (39 per cent) and 522 women (61 per cent), who filled in an anonymous questionnaire six months after their hospital stay. The sample included maternity patients, but we are not given their share of the total.
For first-hand anecdotal accounts of childbirth experiences in the Soviet Union, see Hanson and Lidén (1983, pp. 22, 75, 105–6, 147–8), a collection of thirteen unofficial interviews which were tape-recorded in Moscow in the spring of 1978 by two Swedish women journalists, Carola Hansson and Karin Liddn; and Women and Russia (Mamonova and Matilsky, 1984, pp. 101–5), the first feminist samizdad (underground) publication almanac. See alsoispa (1983) who has conducted interviews about childbirth experiences with 30 Soviet women, who recently emigrated to the United States. Ispa (1983, p. 3) found that ‘horror’ stories about inadequate sanitation, poor food, overcrowding, and rudeness and neglect on the part of hospital personnel abound; on the other hand, some of the women interviewed expressed complete satisfaction with their experience. Officially, care is entirely free, but most of the women reported that ‘tips’ to nurses and doctors were expected and that women who do not offer money or who have not established personal connections received inferior care.
However, this was not always the case. In the UK in the early twentieth century, both infant and maternity mortality rates were compared with those of other countries as ‘indices of national strength and international supremacy’ (Oakley, 1982, p. 672). In fact, the failure of the British maternal mortality rate to fall during 1838–1936 was the main impetus for the development of a national system of antenatal care. See Lewis (1980) and Oakley (1983) for a detailed discussion of the political implications of stagnating and unfavourable (in comparison with other countries) maternal mortality rates in the UK during the first half of this century.
However, throughout the 1970s, there has been tremendous improvement in both the survival and long-term outcomes of premature, low birth weight babies. Today, the majority of infants survive at birth weights between 800 and 1000 grams or 30 weeks gestation, while a decade ago, 80 per cent of those infants would have died (Cesarean Childbirth, 1981, p. 37).
Similar findings have emerged from the Soviet Union. Hansson and Lidén in Moscow Women (1983, p. 115) report that ‘sexual prudery follows the woman all the way into the delivery room. To give birth to a child is painful, but above all unaesthetic — or so people think. The most common argument against having the father present at the delivery is that it is too grotesque. At most he is allowed to sit in a room next door. Another reason for his absence is that the woman herself can’t always be guaranteed a separate room for delivery. Other women in labor may be present as well!’ Ispa (1983, p. 10) also reports that most of the women in her sample were either amused or horrified by the idea of father’s presence in the labour and delivery rooms. ‘The reasons they gave were telling. Several of the women feared that their husbands would not be able to stand the sight of blood or pain; others commented that they would not want their husbands to see them suffering or less attractive than usual ... Remarks generally suggested that men are weaker than women and should be spared the shock of witnessing or participating in childbirth.’ However, a large teaching maternity hospital in Kiev has recently changed its policy and is now allowing fathers in, on an experimental basis, while only ten years ago, its official claimed that such a policy would never be introduced in the Soviet Union (personal communication from Tova Yedlin and Landon Pearson).
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© 1987 Alena Heitlinger
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Heitlinger, A. (1987). Childbirth. In: Reproduction, Medicine and the Socialist State. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-349-07162-3_10
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