Intended for healthcare professionals

Education And Debate

Has the medicalisation of childbirth gone too far?

BMJ 2002; 324 doi: (Published 13 April 2002) Cite this as: BMJ 2002;324:892
  1. Richard Johanson, professor of obstetricsa,
  2. Mary Newburn, head of policy research (,
  3. Alison Macfarlane, professor of perinatal healthc
  1. a Academic Department of Obstetrics and Gynaecology, North Staffordshire Maternity Hospital, Stoke on Trent ST4 6QG
  2. b National Childbirth Trust, Alexandra House, Oldham Terrace, London W3 6NH
  3. c Department of Midwifery, St Bartholomew School of Nursing and Midwifery, City University, London EC1A 7QN
  1. Correspondence to: M Newburn

    Over the past few centuries childbirth has become increasingly influenced by medical technology, and now medical intervention is the norm in most Western countries. Richard Johanson and colleagues argue here that perhaps normal birth has become too “medicalised” and that higher rates of normal birth are in fact associated with beliefs about birth, implementation of evidence based practice, and team working

    Until the 17th century, birth in most parts of the world was firmly in the exclusively female domestic arena, and hospital birth was uncommon before the 20th century, except in a few major cities. 1 2 Before the invention of forceps, men had been involved only in difficult deliveries, using destructive instruments with the result that babies were invariably not born alive and the mother too would often die. Instrumental delivery with forceps became the hallmark of the obstetric era. In the 19th and 20th centuries, medical influence was extended further by the development of new forms of analgesia, anaesthesia, caesarean section, and safe blood transfusion. The introduction first of antiseptic and aseptic techniques and later of sulphonamides, coupled with changes in the severity of puerperal sepsis, lowered the maternal mortality that had made hospitals dangerous places in which to give birth.3

    Summary points

    Obstetricians play an important role in preserving lives when there are complications of pregnancy or labour

    In developed countries, however, obstetrician involvement and medical interventions have become routine in normal childbirth, without evidence of effectiveness

    Factors associated with increased obstetric intervention seem to include private practice, medicolegal pressures, and not involving women fully in decision making

    Emerging evidence suggests that higher rates of normal births are linked to beliefs about birth, implementation of evidence based practice, and team working

    Medicalisation and safe motherhood

    Maternal mortality in the West fell substantially during the 20th century. The World Health Organization and Unicef …

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