Paper short abstract:

This paper discusses induction (IOL) as a process of (re)production befit with disembodied practices and incongruities involving shifting definitions of risk and labour. Engagement with IOL can be a lens through which we highlight what is unwell with maternity care but also how it can be improved.

Paper long abstract:

Around one-third of pregnant women and people undergo induction of labour (IOL) in the UK. Rates have risen in recent years, and induction now represents a substantial workload in NHS maternity services already under significant pressure. IOL is offered when the risks of continuing pregnancy are believed to outweigh the risks of the baby being born. Yet, its optimal use is itself speculative, given an underdeveloped evidence base on timing and outcomes. Discourse around IOL policy in the UK is entangled with notions of risk and safety (Yuill et al., 2022), laying bare how women and people’s pregnant and birthing bodies continue to be a source of unease and a nexus of social understandings of health and mortality.

Drawing on research conducted in England and Scotland, this paper focuses on the state of IOL in the UK, both from the perspectives of those providing this care and those receiving it. Through our interlocutors’ intersecting experiences, we unfold how IOL has become a process of (re)production befit with disembodied and mechanistic practices and utterances as well as incongruities that involve shifting definitions of risk and labour. We also outline how this process renders pregnant women ‘docile’, relegating them to a ‘good patient’ role and removing their bodily agency, and contributes to moral distress among healthcare professionals. Finally, we discuss how anthropological engagement with IOL can be a lens through which we highlight not only what is unwell with contemporary maternity care but also how it can be improved in the future.

Paper short abstract:

This study aimed to investigate the experiences of women with risk of developing preeclampsia who have had an induced labour. The results show that labour induction is also performed routinely and that women often feel misinformed about their risk condition.

Paper long abstract:

The World Health Organization states that labour induction should have a maximum incidence of 10% of deliveries. However, in Spain the rate is around 30%. Labour induction is an intervention used to terminate pregnancies that for some medical reason put the mother and/or the baby at risk, as is the case with women who develop preeclampsia. The aim of this study was to investigate the experiences of induced labour of people screened with risk of preeclampsia, an exam that is performed in the first trimester of pregnancy to analyse the probability of developing the disease. A seven-month fieldwork was conducted in the obstetric area of a hospital in Barcelona which included observations in consultations and delivery rooms, as well as semi-structured interviews with 16 women in the postpartum period. The results show that induction of labour is not only carried out on women who confirm the diagnosis of preeclampsia, but is also routinely performed on pregnancies that may present some kind of risk or difficulty. Women screened with risk of preeclampsia often feel misinformed about their risk condition and confused about medical decisions, which in most cases do not correspond to their expectations about childbirth decisions.

Key words: Reproductive health; Preeclampsia; Induction of Labour; Reproductive rights.

Paper short abstract:

Aiming at enhancing parents’ experience of birth, gentle caesarean has been recently introduced in some Swiss hospitals. By reshaping the script of the operating room, this technique transforms the experience of parents and practitioners, producing a more humanised medical model.

Paper long abstract:

In Switzerland, one in three deliveries is a caesarean birth, a rate which is one of the highest in Europe and reflects the dominant technocratic obstetric culture. In a social context that nevertheless values vaginal deliveries, caesarean births are often associated with an increased parental dissatisfaction and feelings of disillusionment and failure. Recently introduced in some Swiss hospitals as a consistent and systematic technique, gentle caesarean improves parents’ experiences by allowing their increased participation within the requirements of the operating room. Gentle caesarean enables parents to see their baby’s extraction by lowering the surgical drape and allows new-born, partner and mother to stay together in the operating theatre. This shift disrupts the usual script of surgical birth, where parents and health providers are symbolically and physically separated, and prevents mother and baby separation. The paternalistic medical tradition that deems parents too sensitive to handle the sight of anything surgery-related is thus put into question.

This paper is based on an ongoing research on parents’ experience of caesarean birth in Switzerland, combining ethnographic observations in the maternity wards of two public hospitals and in-depth interviews with couples and health professionals. We intend to examine how gentle caesarean elicits a reconnection of medical teams with parents during surgery and a more satisfactory experience for all involved actors. While documenting parents’ and health professionals’ experiences with this technique, we aim to reflect on Swiss obstetric culture and the promotion of respectful and sensitive practices around caesarean births.

Paper short abstract:

In this paper I will reflect on technocratic births trends in Italy and France. Moving from a research work carried out in both countries, I will explore the main factors leading to a different representation and use of caesarean section and epidural anesthesia in these two European contexts.

Paper long abstract:

In this paper I will reflect on technocratic births trends in Italy and France. Moving from a genealogical and ethnographic research work carried out in both countries, I will explore how, from the 1980s to nowadays, a number of factors (organization of medical work, cost-effective, money-making, perceived risks, legal matters, opposing feminist perspectives, etc.) have led to a different representation and use of caesarean section and epidural anesthesia.

On the one hand, I will underline to what extent medicalization rates are higher than those recommended by WHO in both countries, where the transition from home birth to hospital birth translated into a weakening of midwives’ work alongside women and birthing people.

On the other hand, I will investigate how medical interventions during labour and delivery present different traits in the two countries: caesarean section corresponds to the main birth technology birthing people and health professionals refer to in the Italian context while giving birth with epidural anesthesia appears as the hegemonic birth model in France. As we will see, this situation finds a present-day heritage in the current debate on obstetric violence, and its possible solutions, in these two European countries.

Paper short abstract:

Bangladesh has experienced a precipitous shift toward surgical birth. This paper elucidates meanings of caesarean birth among women in rural settings to argue that caesarean is imagined as a panacea for averting risks, particularly for the baby, and has reconfigured moralities around birth care.

Paper long abstract:

Birth through caesarean is rising worldwide, including throughout the global South. These trends are rightfully met with concern within anthropology and global health circles. Bangladesh has experienced a particularly precipitous shift toward surgical birth, with a ten-fold increase in just over a decade, with most recent estimates suggesting that 33% of births are through caesarean. Much of the national discourse, also reflected in global health discourses, places the onus of ‘unnecessarily’ increasing caesarean rates on women wishing to circumvent the pain and inconvenience of vaginal birth. However, it is critical to understand what aspirations towards and use of surgical birth mean for the women whose bodies are concerned. Based on ethnographic data generated in Kushtia district, Bangladesh, this paper elucidates meanings of caesarean birth among women in peri-urban and rural settings as they navigate a new world of maternal health possibilities in the form of advanced maternal health technologies. It argues that, in Kushtia, advanced maternal health technologies figure centrally in ideas of averting risk for a life transition imagined as increasingly laden with potential injury or harm, particularly for the baby, and opens futurities of birth otherwise. While the promises of surgical birth tend to be oversold in the peri-urban and rural peripheries, where clinical standards are challenging to ensure, conceptualisations of caesarean as the ‘safest’ mode of birth reconfigure moralities of care which manifest in ideas of what is a ‘good’ or ‘right’ type of birth, and familial efforts and responsibilities to ensure the safest type of birth.

Paper short abstract:

This contribution will explore some of the tensions of Rohingya in Bangladesh at the moment of birth, between the domestic space and hospital. The authors of this paper come from different backgrounds and look at birth as well as reproductive health system in a context of refuge.

Paper long abstract:

During pregnancy, Rohingya in Bangladesh experience various tensions. Among these, one gains attention here. Rohingya have finally access to hospitals in refugee camps. For the first time women - whose access to health facilities in Myanmar has been denied over the years - have doors open to maternity centres. In this context, institutions encourage them to give birth in these facilities. Nevertheless, several women prefer to deliver in the domestic space with the daima, namely, traditional birth attendant. In exile they want to keep their traditions alive and give birth at home. What are the impacts of medicalisation of birth? While some medicalisation improves safety, inappropriate use of medical care can reduce safety. Furthermore, institutions keep track of birth rates and have recently started to discipline pregnant women who stay in their shelter to give birth.

This contribution will explore these tensions from a novel perspective. First, the ethnographic material collected in hospitals and at home will be outlined. Second, data will be commented and compared to technical knowledge. The authors of this paper come from two different backgrounds. After one year of fieldwork with Rohingyas, one author will present some of the collected material. Thanks to her field experience as UN midwife, the other will comment upon the ethnographic data. Anthropology has supported collaboration with experts in various domains and this paper will try to further explore this. What can we learn from this combined gaze towards birth and reproductive health system in a context of refuge?

Paper short abstract:

Ethnographic research with pregnant asylum seekers and refugees examines the social and political environments that devalue the reproductive labour of birthing people and those who support them. This paper illuminates the intersections of migrant surveillance and maternity care.

Paper long abstract:

Pregnant asylum seekers in Glasgow, Scotland, are frequently subject to heightened surveillance and testing throughout their pregnancies, which often leads to high intervention births. Categorised as ‘high risk’ as both immigrants and patients, many people express limited ability to refuse such forms of health ‘care’. Drawing on ethnographic research, this paper examines how maternity care intersects with migrant surveillance and racialized healthcare to produce birth experiences that are intensely monitored, managed, and pathologized, reflecting British anti-immigrant ‘hostile environment’ policies. Yet these experiences – medical interventions, intensive monitoring, a deficiency of consent – are not unique to migrants. They also illuminate a wider practice of devaluing the labour of birth, including that of midwives and doulas, as well as pregnant people. Anthropology has provided crucial insights to obstetric violence and racism through its methodological approaches. Ethnographic research before, during, and after birth can reveal the gendered and racialized devaluing of feminized labour by encompassing diverse experiences and perspectives from within and beyond birthing spaces. Rather than blame healtcare providers for negative reproductive outcomes and experiences, this paper seeks to understand the social and political context that devalues birthing migrants and midwives alike, in order to envision better birthing futures for all.

Paper short abstract:

Reproductive health as an apical dimension in anthropopoietic processes. Anthropology as a discipline - a bridge between services and the universe of values of individuals and communities. Fieldwork in communities to renegotiate the very postulates of humanitarian work in "generative" health

Paper long abstract:

The neonatal, infant and maternal mortality rates in Sub-Saharan Africa and the impact on the resilience processes of societies are still unacceptably dramatic.

A solid experience in the field of maternal and child health programs leads us to recognize the inadequacy of contrast strategies due to the lack of integration, into national health systems, of the cultural specificities defining health seeking behaviours. Anthropological knowledge and practices are still myopically considered ancillary tools within strategies whose epistemology and evaluation criteria are anchored to the cost-effectiveness of interventions and to global standards and guidelines.

Anthropology, applied in its various declinations, is thought to become a key tool in daily work with communities, involving attention to social structures across generations, dynamic contexts, the relationships that define individuals’ agency and autonomy in decision-making processes.

Conscious choices that go in the direction of the universal right to access health should move from a "service provision" oriented approach to welcome a circularity and syndemic interdependence of the reproductive health of African communities. This could even renegotiate the lexicon towards a "generative" health, which recognizes the community as responsible and empowered actors.

Practices drawn from the authors’ experience will illustrate operating methods and their consequences in terms of impact of community choices on “generative health”. Moreover, it will also validate the work of analysis and revision of the assumptions of the humanitarian operators towards a daily commitment, both in development and humanitarian settings, aiming towards a new ecology of generative health as conscious choice of communities.

Paper short abstract:

What can we do to ensure maternal mental health for solo parents who are planning families beyond the traditional heteronormative nuclear family structure?

Paper long abstract:

Solo motherhood through donation has increased in popularity since the 1980s, and, according to one leading global sperm bank, today about 50% of women ordering donor sperm are intended solo mothers (Cryos). Even though recent research shows that children born to solo parents through donation thrive and are not disadvantaged emotionally nor psychologically (Parke 2013, 140; Golombok et al. 2017, 1973-4; and Roth 2016, 42), solo parents by choice are often presented as reckless, selfish and negligent in anti-donation bioethical discourse and also within contemporary culture (especially tabloid media). The decision to ‘go solo’ can be a difficult, even traumatic, decision – worsened by anti-donation views in wider society.

In this paper, I consider what can be done practically to support solo parents and protect their mental health during their conception journeys. I will focus on the importance of incorporating the lived-experience of patients during clinical training and how procedures and policies in fertility clinics need to be adjusted to prioritise maternal mental health for this particularly vulnerable group. I will discuss the recent construction of the ‘Independent Family Planning: Choosing Solo Parenthood through Gamete or Embryo Donation’ (2023) booklet designed for fertility clinics in the United Kingdom. The objective of this booklet, designed by solo parents, is to highlight to industry professionals the lived experiences of solo parents at the stages of family planning, choosing donor gametes, embarking on the conception journey, pregnancy, and birth. Discussion of this project works to illustrate practical measures that can be taken to address discrimination towards one-parent families and to further identify donor conception pathways as a reproductive right and a legitimate form of family planning.

Paper short abstract:

Developing the concept of birthing ecologies, this paper proposes a sensory material methodology to studying midwifery birthing care practices. This shifts the focus away from dominant evidence based approaches towards realizing and acknowledging a midwifery-specific knowledge corpus.

Paper long abstract:

In European countries, most births take place in hospitals, where midwives and obstetricians work together. Even though midwives are the primary professionals legally responsible for birthing care, obstetricians are often in charge in clinical surroundings. The academisation of midwifery is underway, fuelled by the hope that a ‘proper’ midwifery science will legitimize midwifery birthing care.

This nascent midwifery science faces challenges: adopting medical paradigms and principles such as evidence-based medicine, venerated as ‘scientific’ and rational, promise a gain of professional recognition. Evidence-based midwifery, however, does not permit an understanding of the particularities of midwifery care, its relational and artisanal dimensions, subsumed under midwifery art. They risk eroding midwifery-specific knowledge and birthing care practices.

Drawing on insights from anthropology of care, we propose a methodology to study midwifery birthing care practices, aiming to theorise midwifery practices on their own terms. We engage with identifying and applying a care-specific methodology which reflects the processual, contingent, and relational character of midwifery care practices beyond a mere application of evidence. Building on works in anthropology of the senses, we develop a sensory-material approach, thereby realizing and acknowledging a midwifery-specific knowledge corpus. Employing ideas from STS, we propose the concept of ‘birthing ecologies’ to explore sensory-material modes of togetherness in midwifery birthing care techniques. In doing so, we move past power dynamics between obstetricians and midwives. Alternatively, we articulate the intertwinements of medicine and midwifery, contributing to shaping midwifery science into a resonant, reflective extension, and theoretical condensation of midwifery care practices.

Paper short abstract:

The discourse of homebirth as unsafe reached its peak during the pandemic in 2020. Birth attendants were adamant about how dangerous this is, as women continued the practice because they felt much safer at home. Using a visual ethnographic approach, I explored what it means to be safe during birth.

Paper long abstract:

Seen as an alternative to dominant hospital birth, many women and birth advocates in Slovenia want the accessibility of homebirth to be part of the norm, included in the public health care system. The visibility of issues like obstetric violence and birth trauma has reached its peak during the COVID-19 pandemic; at one point homebirth became illegal for one month in 2020, as well as women’s partners not being allowed to be present in hospitals. The discourse of homebirth is, to say the least, a contentious matter for the public and the healthcare system, further amplified by the media.

During my fieldwork in 2021, I met a young midwife who attended homebirths, which is rare in the Slovenian context. Through her, I met a family who planned a homebirth. Using an audio-visual approach I followed their path from pregnancy, to birth and after. With the visual research, I intended to look at the contentious discourses prevalent in the public about homebirth, countering them by focusing on the dynamics of a homebirth. Using visual methods in anthropological research, I set out to reflect the need to envision a different birth in the Slovenian cultural sphere, where the forefront are the dynamics between the woman, her family, birth attendant (doula), and midwife. Setting out to look at questions: how can we as anthropologists use visuals to better understand the social dynamics of a homebirth and how can we face our own biases when engaging in the anthropology of birth and its politics?