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Health Studies
Denis Maxwell

HLTC02 WINTER 2013 Week # 7: Analysis of a Dialogue on Risks in Childbirth by Patricia Kaufer & John O’Neil Introduction  Focus of article is on birth and risk of Birth differentiating the languages used to describe this in epidemiological, medical and “lay” (read: Inuit) discourse/language  Researchers’ concern is how these languages of risk may be used to affirm or challenge existing relationships of power and control or to express deeply held feelings of vulnerability and responsibility  Epidemiologists and Risk: risk exists as a statistical construct, a product of analyzing aggregate data in a particular way  Medical professionals and Risk: risk of epidemiologists is inserted with medical professionals own arguments of childbirth; use a lowering of risk as the justification for new forms of technical or clinical intervention into the birthing process  Midwives claim their form of delivery is less interventionists, less technological and therefore more immune to iatrogenesis and argue hospital birthing is more dangerous (medicalization of childbirth)  Add a more political, more emotionally suffused content to their languages of risk whether lay or clinical  “Language” means much more than words but also describes concepts, values, symbolic forms  Language and discourse are different  Discourse – form of historical conversation about childbirth which has engaged clinicians, nurses, Inuit women, politicians and midwives Background  Area: Keewatin, Inuit women childbirth  Each community in the Northern area of study has a nursing station and staffed by one to four nurses  Routine antenatal care was provided at the nursing stations with most women being seen by a visiting physician at least once or twice during pregnancy  According to official policy, all births should occur at hospital and not at the nursing station and therefore woman were evacuated to either Churchill or Winnipeg 2 to 3 weeks before expected date of “confinement” (interesting choice of words, I believe they meant due date, but perhaps that’s what it felt like to the Inuit Women  confinement because they would be away from their community  Woman might refuse to leave but the pressures to agree to hospitalization were harsher, if she refuses she risks being labeled noncompliant and irresponsible  this will lead to difficulties in the future of getting proper timely health care for the woman and her family  While the problems that evacuation for childbirth caused women were often sympathetically acknowledged (loneliness, fear, worries about their families), official policy became increasingly committed to hospital as the only safe place of birth.  Risk is looked as a concept, value and a symbolic form  At the core of this essay is a piece of dialogue between an Inuit woman and a doctor The Discourse on Childbirth  Structural barriers to childbirth in the North HLTC02 WINTER 2013 o Arctic climate, vast distances, problems of travel and small, scattered communities, transportation of patients and medical professionals and products generated by daily practice of Western Medicine, flights, and weather o As it became logistically easier to transport women south for childbirth (Via flights, landing strips), it became ideologically more and more difficult for administrators to allow birth to continue in the communities.  Obstetric policy – direct effects (pregnant women could be evacuated more easily) vs. indirect effects (perceptions of accessibility changed)  Central to discourse of childbirth constituted by the government o First = comparison with Southern Canada; Second = note of self congratulation  Comparisons of infant and perinatal mortality rates became particularly important as these rates were recognized internationally as indicators of community well being. The gap between the rates in the north and in southern Canada justified government intervention in childbirth. The decline in rates then became the public proof of the virtue of government policy. For these reasons, the discourse on childbirth has always been as much about politics as about medical care.  Due to departure of nomadic life to costal communities (because of changing caribous migration patterns) there were crowding diseases such as TB being spread (housing conditions, sanitation and nutrition was poor in these settlements) -> people died, sent to sanatoriums, costs to community was high (disruption, demoralization)  Midwifery was not legal – they still became the lynch pin of obstetric policy o According to professionals: midwife was resourceful, self-reliant, independent, and possessed innumerable skills that young medical professionals didn’t have o According to Inuit women: she was a positive figure at the center of childbirth experiences but also recalled as the representatives of the government as authority figures, with paternalistic and colonialist overtones  Canadian women supported midwifery as a matter of principal, Inuit women supported them through their own experiences of birthing in a nursing station attended by a midwife  Changing images of nursing stations too o Birthing without inducing was seen as longer possible or allowed o Nursing station became an unacceptable place of birth  “But as in the debate over home versus hospital births in the United Kingdom, the presumption of a causal linkage is not only nonproven. But unlikely to be ever established (MacFarlane and Mugford 1984). The number of births are too few and the range of variables too many for any form of retrospective analysis. The alternative might be a controlled comparison of the relative risk of nursing station versus hospital birth, but such a study is unlikely, as no health professional would
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