Expert on her own body: contested framings of risk and expertise in discourses on unassisted childbirth

Abstract

In spite of transitions to the culture of childbirth in late 20th century developed nations, the past decade has seen a rise of a new movement advocating for unassisted childbirth – that is, childbirth managed entirely by the labouring woman and in the absence of medical doctors, midwives or other professionally-trained caregivers. Unassisted childbirth advocates have generated an intense debate regarding who should define and control the childbirth experience, presenting a profound critique of the medical management of childbirth. This thesis examines risk discourses on unassisted childbirth as articulated by three key stakeholder groups: physician organizations, the midwifery community and unassisted childbirth advocates. Through a discursive analysis of public and professional written media on unassisted childbirth published between 1994 and 2012, I argue that for all three of the stakeholders, childbirth is typically framed in terms of a language of risk and safety; however, the conceptualizations of what constitutes risk and safety varies considerably among the three groups. Physicians argue that childbirth itself is an inherently risky process in need of medical supervision and management, while unassisted childbirth advocates argue that the real risks arise from the devalorization of birthing women’s knowledge of their bodies and in relying on medical experts to manage birth. Midwives appear to have a more complex framing of risk in childbirth, often mediating between dominant biomedical notions of risk and their own focus on birth as healthy and normal. This thesis adds to the literatures on the sociology of risk and childbirth by highlighting risk as an area of contestation, as experts and lay people interpret and make judgements about expertise, health, safety, autonomy and medical control in relation to childbirth. In addition, the findings demonstrate the continuing tensions and debates in the early 21st century around the quality of the birth experience, the medical management of childbirth and women’s decision-making in regards to reproduction.