Abstract
The article argues against the common notion ofdisciplinary medical traditions, i.e. Obstetrics, asmacro-structures that quite unilinearily structure thepractices associated with the discipline. It shows that the various existences of Obstetrics, their relations with practices and vice versa, the entities these obstetrical practices render present and related, and the ways they are connected to experiences, are more complex than the unilinear model suggests. What allows participants to go from one topos to another – from Obstetrics to practice, from practice to politics, from politics to experience – is not self-evidently induced by Obstetrics, but needs to be studied as a surprising range of passages that connect (or don't). Techniques and devices to supervise the delivery, to render present the fetus during pregnancy, and to monitoring birth, are described in order to show that such techniques acquire different roles in connecting and creating Obstetrics as a system andobstetrical practices.
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NOTES AND REFERENCES
Madeleine Akrich is researcher at the Centre de Sociologie de l'Innovation of the Ecole Nationale Superieure des Mines in Paris. Bernike Pasveer is assistant professor at the Faculty of Arts and Culture of the University of Maastricht. We thank our respective and shared colleagues for their constructive and stimulating investments in our work, the editors of this issue, Dick Willems and Rein Vos for their comments on this article, and the people who have provided us with or acted as our 'data' for their contribution.
Arney WR. (1982), Power and the Profession of Obstetrics. Chicago [etc.]: The University of Chicago Press.
This evolution has also been denunciated by feminist analysts who pointed out that women now cannot do without the mediation of medical professionals to get access to their own body and to their baby, and even that, in some cases, they are negated as individuals whose existence, will, desires exist only as an extension of technical medi-ations/ interventions in their bodies. See for example: Duden B. (1993), Disembodying Women. Perspectives in Pregnancy and the Unborn. Cambridge and London: Harvard University Press; Ploeg, I. van der (1998), Prosthetic Bodies. Female Embodiment in Reproductive Technologies. Maastricht: Ph.D. Thesis.
We draw upon data gathered for a comparative study of Dutch and French obstetrics. See Akrich M., Pasveer B. (1996), Comment la Naissance Vient Aux Femmes. Paris: Les Empê cheurs du Penser en Rond.
We 'play' with the national origins of our data as we have come to realize that 'country' as the unit of analysis is not self-evident. Without wanting to suggest that 'Dutch' and 'French' obstetrics are similar, we'd like to open up the possibility of finding associations along other lines than geographical ones.
Some 8% of all births are surveilled by general practitioners. Source: Obstetrics in the Netherlands, Trends 1989–1993. Utrecht: SIG Care Information.
These are called 'policlinical deliveries'. Policlinics are 'out-patient wards', but a policlinical birth takes place in the normal maternity wards: the responsible professional makes a hospital-based birth either policlinical (midwife) or clinical (obstetrician).
Haut Comité de la Santé Publique (1994). La sécurité et la qualité de la grossesse et de la naissance: pour un nouveau plan périnatalité. Paris: Editions de l'ENSP.
For example, as expressed in Muszynski C., Lambert P. et al. (1994), Les maternité s publiques de proximité dans l'organisation des soins aux femmes enceintes. Dossiers de l'Obsté trique, 214, 33–35; Ossart J. (1994). Donné es et logique é conomiques d'une mater-nité type de <300 accouchements menacé e de fermeture. Dossiers de l'Obsté trique, 223: 12–13.
Nisand, I. (1994). Démédicaliser ou humaniser? Les dossiers de l'Obstétrique n, 213: 15.
Ibid.
Of late, ultrasound check-ups are moving up the ladder of routine prenatal care. Without having become standard in obstetrical practice, a large and increasing percentage of pregnant women see the fetus at least once during a 'normal' pregnancy. Where this technology will go, and what it will 'do' to the division of competencies, power and to the frontiers of normal and pathological, is unclear.
It must be noted that 'expectant' obstetrics — that is: professionals trying to interfere as little as possible or only at the actual presence of pathology rather than preventively — also organizes clinical births. Thus clinical births may resemble those in other western countries but they do not necessarily do so: monitoring, infusion, epidural, episiotomy etc. are no routines; a delivery is named 'clinical' if an obstetrician becomes responsible for the process instead of the midwife.
We proceed here on the basis of observations one of us did in some (3) Dutch midwifery practices. Consultations hours of midwives and their clients have been observed, interviews have been done with the midwives concerned, and some (between 3 and 5) of their clients have been interviewed about their experiences. Of course, in any quantitative sense such amounts do not allow for any generalizations about 'dutch obstetrics' — yet their variety alone allows for our claim that practices of obstetrics exist that simulteneously differ from one another and collude with the general organization of Obstetrics. Moreover, they are productive of that very organization as well as of the articulation of hopes we might have of moving specific practices elsewhere.
See note 7.
Elsewhere we argue that the increasing tendency to constitute a woman's knowledge of her pregnancy through a variety of apparatus and people might influence the wish or competency (of woman and midwife) to give birth without these excorporal sources of information – at home, for example. See Pasveer B., Akrich M. (1998), Hoe lichamen circuleren. Tijdschrift voor Genderstudies, 1, 3, 47–55; Pasveer B., Akrich, M. (forth-coming), Passages: On Coordination Devices in Dutch and French Obstetrics. In: Vries, Ray de et al. (eds), Birth By Design.
See Latour B. (1996), Trains of thoughts, Piaget, Formalism and the Fifth Dimension, Common Knowledge, 6, 3: 170-191, for a description of trajectories travelled with the deliberate goal of going smoothly from a to b without any occurrance on the way standing out and lending itself as a memory, something breaking the flow-and trajectories travelled because of the travelling and designed in order to make events, occurrences, objects stand out as markers of the travelling. The first midwife makes for her client a smooth obstetrical trajectory, the second articulates the travelling more explicitly, and organizes memorable obstetrical markers. 18 In 1991, about 6 out of 10 births were accompanied by a form of analgesia, including births by caesarian sections. It is likely that this proportion has increased since then. Groupe IMAGE (1997), L'obstétrique en France, deuxiè me partie. Groupe d'Animation et d'Impulsion National, Caisse Nationale d'Assurance Maladie, 145.
In 1991, about 6 out of 10 births were accompanied by a form of analgesia, including births by caesarian sections. It is likely that this proportion has increased since then. Groupe IMAGE (1997), L'obsté trique en France, deuxiè me partie. Groupe d'Animation et d'Impulsion National, Caisse Nationale d'Assurance Maladie, 145.
Latour B. (1987), Science in Action. How to follow scientists and engineers through society. Milton Keynes: Open University Press, 150, 182 and 245.
According to the French standard expulsion should take maximum half an hour; according to Dutch standard practice expulsion for a first-born can take two, otherwise maximum one hour.
See for an elaboration of this point: Pasveer B., Akrich M. (1996). Hoe kinderen geboren worden. Kennis en Methode, 20, 1: 116–145.
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Akrich, M., Pasveer, B. Multiplying Obstetrics: Techniques of Surveillance and Forms of Coordination. Theor Med Bioeth 21, 63–83 (2000). https://doi.org/10.1023/A:1009943017769
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DOI: https://doi.org/10.1023/A:1009943017769