Abstract
This chapter examines the cultural view, or set of shared understandings, held in the U.S. about preterm birth. Childbirth is understood to be a medical phenomenon; medical authorities guide the interpretation of the childbirth experience, and provide interventions that are supposed to guarantee a successful birth. The medicalized view of childbirth is situated in a broader framework of social reproduction, which is the way a society determines how it will continue across generations. Within the framework of social reproduction in the U.S., fetuses are believed to have an independent existence beginning early in pregnancy, and mothers are thought to be responsible for the outcomes of their pregnancies and for the progress of their children through adulthood. Beliefs about preterm birth in the U.S. reinforce the medicalization framework, and also shift the responsibility from medical authorities to mothers if pregnancy outcomes are not successful. Understandings of preterm birth also support the belief that fetuses exist independent of their mothers, while the compassion generated in the context of care of preterm newborns echoes the cultural premise that such emotions are appropriate for the care of children, while they are inappropriate in other social spheres. There are many similarities between the U.S. and other countries in the cultural views of medicalized childbirth and social reproduction, but there is also more stigmatization of reproduction among specific subgroups in the U.S., so that successful reproduction is thought to be more of an individual than a society-wide concern.
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Notes
- 1.
The cross-cultural study of the ways that pregnancy and childbirth are understood is very revealing about the ways societies understand the relationship of humans and nature. Interpretations of pregnancy and childbirth also reflect power relationships and beliefs about reproduction (Ginsburg and Rapp 1991). For a discussion of the conflicts that arise when the understandings about pregnancy in a Western culture (in this case Canada) are imposed on pregnant women from an indigenous culture (in this case, the Inuit) with very different models of the meaning of reproduction, see O’Neil and Kaufert (1990). For a good illustration of the ways models of pregnancy weave into other aspects of cultural understandings, see Ivry (2010).
- 2.
Such beliefs form the basis of stratified reproduction . The designation of which women should or should not be encouraged to reproduce reflects the configuration of power relations in the society. Reproduction refers not only to conception and pregnancy but also to child rearing. The situation in which women of a certain ethnicity or race are hired as child care workers to take care of the children of more privileged groups, while confronting obstacles to their ability to take care of their own children, is also an example of stratified reproduction (Ginsburg and Rapp 1995).
- 3.
Davis Floyd includes the typical patterning of physician–patient interaction during prenatal care visits, the treasuring of ultrasound records as baby photographs, and the routines imposed on the delivery experience as examples of rites of passage rituals, and also notes that contemporary Western cultures seem to lack a ritual for reintegrating pregnant women, transformed into new mothers, back into society in a changed way (Davis Floyd 2003).
- 4.
- 5.
Bridges observes that part of the Medicaid-prescribed protocol for care of the high-risk (that is Medicaid covered) women in her clinical setting included multiple (including post-pregnancy) tests for sexually transmitted diseases (STD), and early pregnancy screening for gestational diabetes. She interprets the enhanced STD surveillance as a reflection of the stereotyped view of the nature of the entire Medicaid covered population as sexually promiscuous. In the case of the gestational diabetes screening, she reports that clinicians she spoke with could not really explain the clinical value of the early test, because they knew of no other population with similar testing to use as a standard for what to expect. They were considering using the data from the practice in a scientific publication (Bridges 2011).
- 6.
To avoid disparaging the midwives active in their youth, these informants held that something had changed in the biology of modern women which made it optimal for them to use modern health care.
- 7.
More recent editions of the textbook emphasize the importance of establishing gestational age or maturity of the fetus through functional measures in order to make treatment choices.
- 8.
Thomas Aquinas’s Summa Theologica, Part II, Question 118, Article 1, Reply to Objection 4, reads in part: “In perfect animals, generated by coition, the active force is in the semen of the male, as the Philosopher says (De Gener. Animal. ii, 3); but the foetal matter is provided by the female … And after the sensitive soul, by the power of the active principle in the semen, has been produced in one of the principal parts of the thing generated, then it is that the sensitive soul of the offspring [=the foetus] begins to work towards the perfection of its own body, by nourishment and growth (Knight 2014).
- 9.
Anthropologist Sarah Franklin provides an extensive discussion of the way that Western beliefs about patriarchal descent made it difficult for early European and American anthropologists to understand the kinship systems they encountered, which did not always consider male–female intercourse to be the basis for reckoning relationships over generations. Contrary to original popular belief, this did not mean that individuals living in these cultures did not connect intercourse with pregnancy, and were therefore more primitive or less intelligent than those who did. Rather, it means that this understanding of the biology of conception is not the basis for assigning membership or describing relationships over generations in these non-Western societies (Franklin 1997).
- 10.
Interestingly, this use of ultrasound as a way of encouraging women to identify as mothers to their babies is particularly characteristic of contemporary Western societies. Mitchell and Georges contrast the use of ultrasound in Canada, where the technology is used to frame the fetus as a baby, and in Greece, where the technology is used to encourage traditional women to be more “modern” and European, see (Mitchell and Georges 1997).
- 11.
- 12.
The researchers, writing in the discussion section of their publication, clearly thought that funding more research to find modes of prevention would be the preferable use of funds.
- 13.
Layne notes that in her experience obstetrics care providers abruptly stop providing care for former patients who miscarry and are no longer pregnant, transferring them to the care of other medical personnel. Friends and acquaintances are unsure what to say to parents whose pregnancies end in miscarriage or fetal loss, and often avoid the subject. One of her informants noted that there are even greeting cards to send to people whose pets die, but nothing for individuals experiencing pregnancy loss (Layne 2003).
- 14.
Michie and Cahn (1997) note that this is a very common rhetorical device in What to Expect When You’re Expecting, which often begins topics with a reassuring tone that supports autonomy, choice and diversity and minimizes the negative consequences of actions, and then moves on to seem to prescribe exacting maternal behavior to assure positive pregnancy outcomes.
- 15.
Newspapers that yielded articles included The New York Times, The Washington Post, USA Today, The Chicago Sun Times, The New York Daily News, The St. Louis Post-Dispatch, The Minneapolis Star-Tribune, The Houston Chronicle, The St. Petersburg (FL) Times, The Atlanta Journal-Constitution, The Denver Post and the Philadelphia Inquirer.
- 16.
Linda Layne notes the same phenomenon applied to pregnancy loss, reframing the miscarried fetus, or stillborn baby as a gift (Layne 2003).
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Bronstein, J.M. (2016). The Cultural Dimension: How We Understand Preterm Birth. In: Preterm Birth in the United States. Springer, Cham. https://doi.org/10.1007/978-3-319-32715-0_3
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Print ISBN: 978-3-319-32713-6
Online ISBN: 978-3-319-32715-0
eBook Packages: MedicineMedicine (R0)