Monday, May 21, 2007

Bewitched by the claim that pregnancy is a natural process

One of the fundamental themes of homebirth advocacy is the failure to understand what childbirth in nature is really like. Hence the claim by "natural" childbirth advocates that pregnancy is not a disease. Such a claim is meaningless and irrelevant on empirical grounds, since childbirth is a leading cause of death for both women and babies. The reflexive rejection of the medical nature of natural events makes no sense on philosophical grounds, either.

Feminist scholar Laura Purdy discusses this in her article Medicalization, Medical Necessity and Feminist Medicine. She questions the philosophical basis for the rejection of medical technology in the realm of childbirth. Purdy notes that:
...[W]e tend to be bewitched by the claim that pregnancy and menstruation are natural processes and thus inappropriately dealt with by the medical realm.
...[T]he need to reject appeals to nature as guides to action has long been clear in bioethics: defining states of affairs as 'natural' or 'normal' implies nothing about how to deal with them. When we learn that ... horrifying numbers of Third World women are dying [in childbirth] even as we speak, nobody concludes that preventive action would be morally intrusive.
Purdy asks if women's health and reproduction should be excluded from the medical realm, and answers:
Surely not. First, even in the best circumstances, a few women would require all the help that medicine can offer, and such help needs to be made available to them ... Second, allegedly commonsense measures that alleviate misery and promote health are often based (even if we fail to recognize it) on scientific and medical knowledge...
Folk remedies may be based on intelligent observation, but, like the notion that women in obstructed labor are helped by feeding them mucus from donkey's nostrils, they may be unhelpful or even harmful...
Purdy recommends a different attitude toward medicalization:
To 'demedicalize' is not to deny the biological components of experience but rather to alter the ownership, production, and use of scientific knowledge. So women must use medical means for our own ends, whether to reduce pain or shape our own lives...
This philosophical critique of the reflexive rejection of medicalization has several important implications:

The fact that childbirth is "not a disease" tells us nothing about whether medical technology should or shouldn't be used.

It is not intrinsically desirable for women to reject medical interventions, it is only desirable that women control medical interventions.

Much of what homebirth advocates deem to be commonsense knowledge about birth actually depends upon medical and scientific knowledge.

Some techniques of self care (folk wisdom) are harmful.

The bottom line is that there is no inherent value to demedicalizing childbirth, since childbirth is empirically dangerous to women, and since feminism does not require and should not promote the reflexive rejection of medical technology.

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