by Sarah Earle

In the last thirty years, women's experiences of childbirth have changed dramatically in that, for many, the chances of having a normal birth, that is one without medical intervention, are slim. Most of the women in the UK will have experienced at least one of the medical interventions described below. Indeed, of the 600,000 or so deliveries in the UK each year, it is estimated that less than half of these could be described as 'normal'. Routine interventions in childbirth include:

• artificial rupture of membranes
• caesarean section
• continuous electronic foetal monitoring
• epidural anaesthesia
• episiotomy
• recumbent birthing position

Childbirth has become an increasingly medicalised phenomenon whereby the majority of women no longer experience or have knowledge of what it is to give birth to their baby without interference. Almost all women give birth in hospital and the majority are subjected to a cascade of medical and technological interventions throughout pregnancy and birth.

In England, most recent figures (DoH, 2004) suggest that twenty per cent of deliveries are artificially induced or accelerated. Thirteen per cent of women have an episiotomy and one third have an epidural, general or spinal anaesthetic during labour. These same figures also suggest that 11 per cent of women have instrumental deliveries.

Perhaps, and most worryingly, the number of caesarean deliveries has also increased dramatically in the last fifteen years. Whilst the World Health Organisation recommends that the caesarean rate should be no more than 10 – 15 per cent, the average caesarean rate across the UK is 22 per cent. Indeed, many hospitals in the UK now have caesarean rates that exceed 25 per cent (BirthChoice UK, 2005).

Justification for the medicalisation of birth
Several explanations have been put forward to justify the medicalisation of childbirth. Concerns with safety, defensive medical practice and the concept of women's choice are particularly significant.

Safe motherhood?
The medical model of childbirth assumes that the female body is always ready to fail. Indeed, childbirth is seen as a highly risky business. The majority of women who give birth in hospital do so because they assume that a hospital birth is safest. However, all the research evidence that exists demonstrates that, for a healthy woman with a normal pregnancy, a planned home birth is as safe as a hospital birth (BirthChoiceUK, 2005). In spite of this research evidence, not everybody agrees, and many health care professionals insist on claiming that a medicalised hospital birth is still the safest option.

Defensive medicine
There has been an alarming increase in litigation against the NHS over the last few years. In fact, 70 per cent of all litigation involves obstetric cases (Johanson et al., 2002). Not surprisingly, defensive medical practice has been identified as another reason for the increasing medicalisation of childbirth.

We live in a society where relatively few babies die and, when they do, it is assumed that someone or something must be blamed. However, defensive practice serves to undermine clinical decision making for the benefit of women and their babies in favour of practices, such as caesarean delivery, which serve to protect the medical profession.

Choice in childbirth
The report, Changing Childbirth, enshrined the concept of 'choice' within the maternity services and it has been suggested that the increased medicalisation of childbirth can be attributed to the kinds of choices that women themselves make. For example, it has been argued that an increasing number of women are choosing a caesarean birth. Whilst this is true, it is worth noting that only seven per cent of caesareans are performed at maternal request (RCOG, 2001).

Many have argued that choice in childbirth is merely an illusion and that we often talk about choice as though it were the single most important factor when thinking about women's experiences of birth. But when medical interventions are presented as routine and when women are encouraged to make 'choices' that will be better for their babies, then it is easy to see how women's choices are being managed within a medical model of childbirth.

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