Thursday, April 23, 2009

An OB on industrialized childbirth and maternal autonomy

Just after I posted my book review of Policing Pregnancy, someone sent me a link to a fantastic article about the factory model of childbirth, the rising cesarean rate, and the limits of pregnant women's autonomy. It was written by an obstetrician, Lauren A. Plante: "Mommy, what did you do in the industrial revolution? Meditations on the rising cesarean rate." International Journal of Feminist Approaches to Bioethics Spring 2009, Vol. 2, No. 1, Pages 140-14.

For some tantalizing excerpts from Plante's article, read An Essay on the Factory Model of Childbirth at the Our Bodies, Ourselves blog. I have the full text of the article, so email me (stand.deliver at if you'd like a copy. It is definitely worth the read!

A few of Plante's observations about autonomy that I can't resist including here:
In the US, we have heard arguments that women are entitled to autonomy in making their birth choices, and that therefore it is ethical to perform cesarean for no reason other than maternal request. Curiously, this vaunted autonomy stops at the door of the labor room. Women are implicitly allowed, or encouraged, to make only those choices which increase the power of the physician and which decrease their own....

The American College of Obstetricians and Gynecologists calumniates not only women who want a home birth but anyone who advocates leaving that option open. Once in the hospital, women who might like to exercise their right to self-determination by choosing vaginal birth after cesarean, or vaginal breech delivery, will have a hard time of it. Is it not the opposite of autonomy to support only those choices which increase the woman’s reliance upon the physician?...

We must clearly understand that real autonomy does not mean cesarean on request, but instead a spectrum of birth options that honor women’s authentic choices. Real autonomy also means, to borrow a sentiment from Gandhi, that women should bring forth the change they wish to see in the world.


  1. I agree absolutely with the last thing you said; it's women who have to work for what they want. The midwives aren't going to do it. The "movement" has it's own agenda and skin in the game ( no pun intended ). As soon as midwifery became about gaining credibility from the health care industry instead of working in partnership with motherbabies to create a workable, sustainable system of maternal health care; half the war was lost. Midwifery is, or ought to be, simple, sustainable health care that is community based and easily affordable. Nice job and how are you doing?

  2. What a coinkydink! I just signed up for their listserve.

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