Obstetrical authority

“It was mediated in large part by the development of new medical technology and, perhaps more important, by the perception of the effectiveness of this technology by both medical professionals and the laity (Leavitt II, 230-31). . . . At the end of the 19th century the available procedures (in the order in which physicians would have considered them) included a high forceps operation, or internal version with forceps application on the after-coming head; symphysiotomy, the surgical separation of the pubic bones; pubiotomy (also called hebotomy), the cutting of the pubic bone to increase the conjugate diameters; cesarean section, the delivery of the fetus through an incision in the abdominal wall; or craniotomy, the reduction by various operations of the size of the fetal head so that it would fit through the pelvic opening” (233). . . . Technical criteria for selecting between craniotomy and cesarean section occupied physicians’ attention for years and caused heated arguments at medical society meetings (236). . . . In favor of their [physicians] autonomy and authority was their exclusive control of the technical information necessary to both decision making and execution of certain procedures. Some of the objective information, including pelvic measurements and estimation of the size of the fetus, although open to interpretation, remained in the hands of medical observers alone” (241). . . . [Yet] such control over information did not necessarily lead to their ultimate power in decision making . . . extramedical factors that they felt they could not control. . . . [re surgical intervention] parturients had to be convinced to move to hospitals . . . . . ethical and religious considers . . . “ . . . medicine itself remained shackled. Women were losing their traditional birth-room powers, and physicians were taking up only part of the slack. Who or what stepped into the breach? . . . Church and husband, both more active birth-room participants in this period” (242). . . . The husband, as a rule, also spoke of the necessity of saving his wife’s life first. The priest, in the case of Catholic families, spoke for the ‘innocent’ fetus over against the ‘guilty’ mother. In the midst of this debate, obstetricians tried to establish medicine’s authority to cast the ‘swing’ vote – indeed, to make medicine’s vote the most important one (244). . . . The new technology make it possible to consider fetal life as a viable option and provided physicians with the opportunity to wrest decision-making power away from its traditional place within the family and establish it in their own domain. It was in these high-risk cases requiring surgical intervention that physicians found their first commanding voice in the birthing room; they later learned to use their new authority in all obstetric cases” (245). Craniotomy came to be associated with the hold ways, cesarean section with the new. . . . Physicians justified their actions on medical ground and in social terms, making social value comparisons between the birthing woman and the fetus. In so doing, they revealed their own biases about women’s role as childbearers” (246). . . . physicians claimed their right to make medical decisions using the whole range of considerations that had characterized collective decision making in the past. . . . Actually, however, the physicians relied just as heavily on their own social ideas as they gained medical authority. They made decisions on both social and medical grounds . . . [they superseded collective decision making with a more unitary professional one] even while they used all the traditional modes of integrating medical with nonmedical considerations” (247).