RUMS Review Vol. VIII Issue I - January 2023

Medicine in the West
has historically had a
tenuous relationship
with the birthing
process and
respecting the needs
of pregnant persons.
In the past, misogynistic attitudes
meant that midwifery and obstetrics
were shunned. One president of the
Royal College of Physicians said that a
doctor practising midwifery would
“disparage the highest grade of the
profession”. However, at present,
medicine has become deeply entwined
with the birthing process. Nonetheless,
it could be argued that pregnant
persons are still not treated with
respect, as the birthing process
becomes ‘over-medicalised’ and
commodified.
In the UK, during the 1800s, the Royal
Colleges of both physicians and
surgeons considered obstetrics and
midwifery an activity outside the remit
of medicine. The same misogynistic
attitudes that kept women out of
medicine also prevented the birthing
process being seen as something
necessitating medical supervision.
Even when maternal care was
provided by GPs at the time, it was
often restricted to just during labour
itself, rather than holistic care of the
mother and child perinatally. For many
GPs, delivering babies was tedious
with low fees, but was a service they
provided in order to keep the patients
as customers for life.
A lens through which we can explore
views towards maternity care is by
contrasting the medical and midwifery
philosophies. The medical philosophy
considers the potential pathologies
that can occur in maternity and aims to
minimise these. It is focused on the
birthing process and preventing
negative outcomes, which might
reflect the views held by GPs in the
19th century. The midwifery
philosophy, on the other hand, aims to
provide holistic care and empower
pregnant persons to be prepared for a
child. It views birthing as a natural,
physiological process that, in most
cases, requires minimal intervention.
These models help to delineate the
differences between care that aims to
avoid risk, and care that aims to
facilitate health.
The medical philosophy of maternity
can still be seen in the modern day. In
many countries, a majority of births
take place in hospitals, with epidural
anaesthesia, induced labour and
caesarean section deliveries becoming
increasingly common. While it is
undeniable that these interventions
have saved lives, in many places these
treatments are routinely administered
without medical indication. There is a
trend of ‘over-medicalisation’ in
developed countries, while many of the
poorest receive insufficient care.
These two extremes are sometimes
described as ‘too much too soon’
(TMTS) and ‘too little too late’ (TLTL).
The paper “Beyond too little, too late
and too much, too soon” by Miller et al.
(2016) explores the widening
inequalities in maternity care. A
commonly used measure is comparing
the proportions of induced labour and
Caesarean section delivery to infant
mortality. While many of the poorest
regions of the world lack access to
such procedures, countries such as
Brazil have seen increased rates of
labour inductions (2.5% to 43.0%) and
Caesarean sections (27.6% to 43.2%),
without any associated decrease in
infant mortality. This shows that while
more resources are spent in maternity
care, it is not spent in an effective or
equitable manner.
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