Skip to main content

The transformations of medicalization of pain relief in the organization of perinatal care system in Quebec

Social Theory & Health volume 19, pages 220–245 (2021)Cite this article

Abstract

This article analyzes the contemporary transformation of the medicalization of pain relief in the organization of the perinatal care system in Quebec. The consequences of this transformation are analyzed specifically through the common recourse to epidural anesthetics to relieve women’s pain during childbirth. Relying on 6 months of ethnographic fieldwork, 26 semi-structured interviews and 24 life history interviews, I discuss the relevance of the concepts of medicalization and demedicalization for a theoretical analysis of this transformation. By taking into account in the analysis the three levels of medicalization suggested by Conrad and Schneider (conceptual, interactional and institutional), I argue that the expertise related to the relief of pain during childbirth is transferred from health professionals to women through a naturalization of women’s competences process. Beyond the notion of social control, I revisit the use of the concept of medicalization to analyze how pain during childbirth could be simultaneously the subject of a double and continuous process of demedicalization and of medicalization. I conclude that the transformations of the Quebec perinatal system cannot be completely part of a demedicalization process but rather part of a form of medicalization where the different levels of medicalization are modulated.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Notes

  1. “A birth center is a location for pregnant women and their families. It is a home at the heart of the community, physical premises different from their own home and the general hospital, and part of the public health network. This facility is designed to welcome a reasonable number of births per year so it can maintain a private, family and human atmosphere. A birth center offers front-line services. The midwives working at the center ensure global care to women and their families – during pregnancy, labor, birth and six weeks postpartum to the mother and child. The environment and midwife philosophy are conducive to normal birth. It is also a highly suitable location for the development of midwife practice, training and research.” Definition of a birthplace, Site of the Ordre des Sages-Femmes du Québec. Nurses work exclusively in hospitals or community structures (Center Local de Service Communautaire (CLSC)—Local Community Service Center).

  2. Elsewhere in Canada: the rate in 2010–2011 was 50.4% in New Brunswick, 52.1% in Alberta and 39.5% in Prince Edward Island. From 2006–2007 to 2010–2011, the rate of epidural anesthesia in obstetrics increased in almost all provinces in Canada, from 53.2 to 56.7% (Canadian Institute for Health Information 2016).

  3. Until the early 1990s, only a few countries, including Canada, did not have midwifery legislation (Hawkins and Knox 2003). The profession of midwifery was first legalized in 1994 in Ontario, 1998 in Alberta and in British Columbia, 2000 in Manitoba, 2004 in Northwest Territories and 2011 in Nunavut (Fraser and Hatem-Asmar 2004).

  4. There are now seventeen birth centres in the province of Quebec. Two birth centers have been established in the province of Ontario in 2014, one community birth center in the province of Manitoba, one birth center in the territory of Nunavut and two private facilities in the province of Alberta. In the other provinces the only possible places for delivery with health professionals are in a hospital or at home.

  5. The diversification of the places for childbirth in Quebec is not an exception. Most countries have experienced this process: England, the Netherlands, Germany, Italy or France in 2013 for example. For more details on the history of midwives in France see the work of historians (Sage-Pranchère 2007, 2017; Laget 1982; Gélis 1988; Beauvalet-Boutouyrie 1999; Knibiehler 1997; Knibiehler and Fouquet 2000; Knibiehler and Héritier 2001; In Canada: Cornellier 1993; Rivard 2014; Saillant and O'Neill 1987; In the United States: Harley 1990; Davis-Floyd 2004; Davis-Floyd and Johnson 2006; Simonds et al. 2007) and for comparisons between Europe and North America see: Ehrenreich and English (2015), Akrich and Pasveer (1996, 2004); De Vries et al. (2002).

References

  • Akrich, M. 1999. La péridurale, un choix douloureux. Les Cahiers du Genre 25: 17–48.

    Google Scholar 

  • Akrich, M., and B. Pasveer. 1996. Comment la naissance vient aux femmes. Paris: Les Empecheurs De Penser en Rond.

    Google Scholar 

  • Akrich, M., and B. Pasveer. 2004. Embodiment and disembodiment in childbirth narratives. Body and Society 10: 63–84.

    Article  Google Scholar 

  • Akrich, M., and V. Rabeharisoa. 2012. L’expertise profane dans les associations de patients, un outil de démocratie sanitaire. Santé publique 24 (1): 69–74.

    Article  Google Scholar 

  • Arnal, M. 2016. Relief the pain of women during childbirth. Deviance and Normalization of the Emotions: Genre, Sexualité and Société. https://doi.org/10.4000/gss.3870.

    Book  Google Scholar 

  • Ballard, K., and M.A. Elston. 2005. Medicalisation: A multi-dimensional concept. Social Theory and Health 3 (3): 228–241.

    Article  Google Scholar 

  • Baszanger, I. 1995. Douleur et médecine, la fin d’un oubli. Paris: Seuil.

    Google Scholar 

  • Baszanger, I. 1998. Inventing pain medicine: From the laboratory to the clinic. New Brunswick, NJ: Rutgers University Press.

    Google Scholar 

  • Beauvalet-Boutouyrie, S. 1999. Naître à l’hôpital au XIXe siècle. Paris: Belin.

    Google Scholar 

  • Berlivet, L. 2011. Medicalisation. Genèses 1 (82): 2–6.

    Article  Google Scholar 

  • Bertaux, D., and M. Kohli. 1984. The life story approach: A continental view. Annual Review of Sociology 10 (1): 215–237.

    Article  Google Scholar 

  • Bonica, J.J. 1953. The management of pain of cancer. Journal-Michigan State Medical Society 52 (3): 284.

    Google Scholar 

  • Brubaker, S. J., and Dillaway, H. E. 2008. Re-examining the meanings of childbirth: Beyond gender and the “natural” versus “medical” dichotomy. In Advancing Gender Research from the Nineteenth to the Twenty-First Centuries, 217–244. Bingley: Emerald Group Publishing Limited.

    Chapter  Google Scholar 

  • Brubaker, S.J., and H.E. Dillaway. 2009. Medicalization, natural childbirth and birthing experiences. Sociology Compass 3 (1): 31–48.

    Article  Google Scholar 

  • Burke, M. C. 2011. Resisting pathology: GID and the contested terrain of diagnosis in the transgender rights movement. In Sociology of diagnosis, 183–210. Bingley: Emerald Group Publishing Limited.

    Chapter  Google Scholar 

  • Broom, D.H., and R.V. Woodward. 1996. Medicalisation reconsidered: Toward a collaborative approach to care. Sociology of Health & Illness 18 (3): 357–378.

    Article  Google Scholar 

  • Canadian Institute for Health Information. 2016. Childbirth Indicators by Place of Residence. Report no. CB1. Canada: Canadian Institute for Health Information.

  • Canadian Perinatal Health Report (2003) Ottawa: Minister of Public Works and Government Services.

  • Chalmers, B., J. Kaczorowski, C. Levitt, S. Dzakpasu, B. O’Brien, L. Lee, M. Boscoe, D. Young, Maternity Experiences Study Group of the Canadian Perinatal Surveillance System, and Public Health Agency of Canada. 2009. Use of routine interventions in vaginal labor and birth: Findings from the maternity experiences survey. Birth 36 (1): 13–25.

    Article  Google Scholar 

  • Carricaburu, D. 2005. From the technical management of risk to the technical management of work: Childbirth in public hospitals. Sociologie du travail 47 (2): 245–262.

    Google Scholar 

  • Carricaburu, D. 2007. De l’incertitude de la naissance au risque obstétrical: Les enjeux d’une définition. Sociologie et Sociétés 39 (1): 123–144.

    Article  Google Scholar 

  • Caron-Leulliez, M., and J. George. 2004. L’accouchement sans douleur: Histoire d’une révolution oubliée. Paris: Editions de l’Atelier.

    Google Scholar 

  • Charrier, P., and G. Clavandier. 2013. Sociologie de la naissance. Paris: Armand Colin.

    Book  Google Scholar 

  • Conrad, P. 1975. The discovery of hyperkinesis. Social Problems 12 (1): 12–21.

    Article  Google Scholar 

  • Conrad, P. 1977. Medicalization, etiology and hyperactivity: A reply to Whalen and Henker. Social Problems 24 (5): 596–598.

    Article  Google Scholar 

  • Conrad, P. 1992. Medicalization and social control. Annual Review of Sociology 18: 209–232.

    Article  Google Scholar 

  • Conrad, P. 2007. The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: The John Hopkins University Press.

    Google Scholar 

  • Conrad, P. 2015. Forword. In Reimagining (bio)medicalization, pharmaceuticals and genetics: Old critiques and new engagements, ed. S. Bell and A.E. Figert. London: Routledge.

    Google Scholar 

  • Conrad, P., and J.W. Schneider. 1980. Looking at levels of medicalisation: A comment on Strong’s critique of the thesis of medical imperialism. Social Science and Medicine 14A: 75–79.

    Google Scholar 

  • Conrad, P., and J.W. Schneider. 1992. Deviance and medicalisation: From badness to sickness, 2nd ed. Philadelphia: Temple University Press.

    Google Scholar 

  • Conrad, P., and M.R. Bergey. 2014. The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder. Social Science and Medicine 122: 31–43.

    Article  Google Scholar 

  • Corbin, J.M., and A. Strauss. 1990. Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative sociology 13 (1): 3–21.

    Article  Google Scholar 

  • Corrêa, M.V., and M.A. Loyola. 1999. Medicalization of reproduction: New reproductive technologies, images of the child and the family among a group of women from the City of Rio de Janeiro, Brazil. Journal of Social Sciences 3 (1–2): 73–87.

    Article  Google Scholar 

  • Cornellier, H. 1993. Créer une nouvelle profession…Vieille comme le monde, la sage-femme professionnelle de la santé au Québec, en comparaison avec la situation de la sage-femme au Canada et à l’étranger. Master’s Degree in Health Law, Université de Sherbrooke, Sherbrooke.

  • Crowley-Matoka, M., and G. True. 2012. No one wants to be the candy man: ambivalent medicalization and clinician subjectivity in pain management. Cultural Anthropology 27 (4): 689–712.

    Article  Google Scholar 

  • Davis-Floyd, R.E. 2004. Birth as an American rite of passage: With a new preface. California: Univ of California Press.

    Book  Google Scholar 

  • Davis-Floyd, R., and J. Dumit. 1998. Cyborg babies: From techno-sex to techno-tots. Londres: Routledge.

    Google Scholar 

  • Davis-Floyd, R., and C.B. Johnson (eds.). 2006. Mainstreaming midwives: The politics of change. Boca Raton: CRC Press.

    Google Scholar 

  • Davis-Floyd, R., and C. Sargent. 1997. Childbirth and authoritative knowledge: Cross-cultural perspectives. Berkeley: University of California Press.

    Book  Google Scholar 

  • De Vries, R., C. Benoit, E. Van Teijlingen, and S. Wrede (eds.). 2002. Birth by design: Pregnancy, maternity care and midwifery in North America and Europe. London: Routledge.

    Google Scholar 

  • Dillaway, H., and S.J. Brubaker. 2006. Intersectionality and childbirth: How women from different social locations discuss epidural use. Race, Gender and Class 13: 16–41.

    Google Scholar 

  • Quebec National Institute of Excellence in Health and Social Services. 2008. La politique de périnatalité 2008–2018. Direction des communications du ministère de la Santé et des Services Sociaux du Québec, Québec.

  • Ehrenreich, B., and D. English. 1972. Witches, midwives and nurses. New York: Feminist Press.

    Google Scholar 

  • Ehrenreich, B. and English, D. 2015. Sorcières, sages-femmes et infirmières. Une histoire des femmes et de la médicine. Québec: Remue Ménage.

  • Fraser, W., and M. Hatem-Asmar. 2004. La sage-femme du Québec: de la renaissance à la reconnaissance. Santé, Société et Solidarité 3 (1): 105–115.

    Article  Google Scholar 

  • Fox, R.C. 1977. The medicalization and demedicalization of American society. Daedalus 102: 9–22.

    Google Scholar 

  • Fox, B., and D. Worts. 1999. Revisiting the critique of medicalized childbirth: A contribution to the sociology of birth. Gender and Society 13 (3): 326–346.

    Article  Google Scholar 

  • Gabe, J., M. Bury, and M. Elston. 2004. Key concepts in medical sociology. London: Sage Publications.

    Google Scholar 

  • Gab, J., and M. Calnan. 2009. The new sociology of the health service. London: Routledge.

    Book  Google Scholar 

  • Gélis, J. 1984. L’Arbre et le fruit: la naissance dans l’Occident moderne:(XVIe-XIXe siecle). Paris: Fayard.

    Google Scholar 

  • Gélis, J. 1988. La sage femme ou le médecin: Une nouvelle conception de la vie. Paris: Fayard.

    Google Scholar 

  • Griffiths, F. 1999. Women’s control and choice regarding HRT. Social Science and Medicine 49 (4): 469–482.

    Article  Google Scholar 

  • Halfmann, D. 2012. Recognizing medicalization and demedicalization: Discourses, practices, and identities. Health 16 (2): 186–207.

    Article  Google Scholar 

  • Harley, D. 1990. Historians as demonologists: The myth of the midwife-witch. Social History of Medicine 3 (1): 1–26.

    Article  Google Scholar 

  • Hawkins, M., and S. Knox. 2003. The midwifery option: A Canadian guide to the birth experience. Toronto: HarperCollins Publishers.

    Google Scholar 

  • Howard, S. 2003. Imagining the pain and peril of seventeenth-century childbirth: Travail and deliverance in the making of an early modern world. Social History of Medicine 16 (3): 367–382.

    Article  Google Scholar 

  • Illich, I. 1977. Limits to medicine: Medical nemesis: The expropriation of health. Harmondsworth and New York: Penguin.

    Google Scholar 

  • Johnson, C. 2008. The political “nature” of pregnancy and childbirth. Canadian Journal of Political Science 41 (4): 889–913.

    Article  Google Scholar 

  • Jordan, B. 1992. Birth in four cultures: A crosscultural investigation of childbirth in Yucatan, Holland, SIden, and the United States. Prospect Heights, IL: Waveland Press.

    Google Scholar 

  • Kitzinger, S. 2006. Birth crisis. London: Routledge.

    Book  Google Scholar 

  • Knibiehler, Y. 1997. La révolution maternelle: Femmes, maternité, citoyenneté depuis 1945. Paris: Perrin.

    Google Scholar 

  • Knibiehler, Y., and C. Fouquet. 2000. Histoire des mères et de la maternité en Occident. Paris: Presses universitaires de France.

    Google Scholar 

  • Knibiehler, Y., and F. Héritier. 2001. Maternité: Affaire privée, affaire publique. Paris: Bayard Jeunesse.

    Google Scholar 

  • Laget, M. 1982. Naissances: l’accouchement avant l’âge de la Clinique. Paris: Editions du Seuil.

    Google Scholar 

  • Lowenberg, J.S., and F. Davis. 1994. Beyond medicalisation-demedicalisation: The case of holistic health. Sociology of Health & Illness 16 (5): 579–599.

    Article  Google Scholar 

  • Macdonald, M. 2006. Gender expectations: Natural bodies and natural births in the new midwifery in Canada. Medical Anthropology Quarterly 20 (2): 235–256.

    Article  Google Scholar 

  • Maffi, I. 2013. Can caesarean section be ‘natural’? The hybrid nature of the nature-culture dichotomy in mainstream obstetric culture. Tidsskrift for Forskning i Sygdom og Samfund 19: 5–26.

    Google Scholar 

  • Mambourg, F., Gailly, J. and Ii-Hong, Z. 2010. Guideline relative to low risk birth. Good clinical practice. KCE Reports 139C. Brussels: Belgian Health Care Knowledge Center.

  • Martin, E. 2001. The woman in the body: A cultural analysis of reproduction. Boston: Beacon Press.

    Google Scholar 

  • Michie, H., and N. Cahn. 1996. Unnatural births: Caesarean sections in the discourse of the Natural Childbirth Movement. In Gender and health: An international perspective, ed. C. Sargent and C. Brettell, 44–56. New York: Prentice Hall.

    Google Scholar 

  • McKee, J. 1988. Holistic health and the critique of Western medicine. Social Science and Medicine 26 (8): 775–784.

    Article  Google Scholar 

  • Morel, M.F. 2007. Histoire de la naissance en France. Actualité et Dossier en Santé Publique 61 (62): 22–28.

    Google Scholar 

  • National Institute for Health and care Excellence. 2014. Intrapartum care for healthy women and babies. Clinical Guidelines no. 190. United Kingdom.

  • Norman, B. M., and Rothman, B. K. 2007. The new arrival: Labor doulas and the fragmentation of midwifery and caregiving. In Laboring on: Birth in transition in the United States, 251–282. New York: Routledge.

    Google Scholar 

  • Oakley, A. 1980. Women confined: Towards a sociology of childhirth. Oxford: Martin Rohertson and Co., Ltd.

    Google Scholar 

  • Oakley, A. 1984. The captured womb: A history of the medical care of pregnant women. Oxford: Basil BlackIll.

    Google Scholar 

  • Purdy, L. 2006. Women’s reproductive autonomy: Medicalisation and beyond. Journal of Medical Ethics 32 (5): 287–291.

    Article  Google Scholar 

  • Québec (Province) Ministère de la santé et des services sociaux, Laverdière, F., Anctil, H., Renaud, M., Bureau, M. A., and Auger, J. 2008. Politique de périnatalité 2008–2018: Synthèse: Un projet porteur de vie. Santé et services sociaux Québec.

  • Rey, R. 1993. Histoire de la douleur. Paris: La Découverte.

    Google Scholar 

  • Riessman, C.K. 1983. Women and medicalization: A new perspective. Social Policy 14 (1): 3.

    Google Scholar 

  • Rivard, A. 2014. Histoire de l’accouchement dans un Québec moderne. Montréal: Remue Ménage.

    Google Scholar 

  • Rossignol, M., F. Boughrassa, J.M. Moutquin, D. Guilbault, V. Baril, and J. Guillot. 2012. Mesures prometteuses pour diminuer le recours aux interventions obstétricales évitables pour les femmes à faible risque. ETMIS 8 (14): 1–134.

    Google Scholar 

  • Rose, N. 2007. Beyond medicalisation. The Lancet 369: 3–700.

    Article  Google Scholar 

  • Rothman, B.K. 1982. In labor: Women and power in the birthplace. New-York: WW Norton and Company.

    Google Scholar 

  • Rothman, B.K. 1989. Women as fathers: Motherhood and child care under a modified patriarchy. Gender and Society 3 (1): 89–104.

    Article  Google Scholar 

  • Rothman, B.K. 1993. The tentative pregnancy: How amniocentesis changes the experience of motherhood. New York: WW Norton and Company.

    Google Scholar 

  • Rozée, V., and S. Unisa. 2016. Assisted reproductive technologies in the global south and north: issues. New York: Routledge.

    Book  Google Scholar 

  • Rumeau-Rouquette, C. 2004. L’effet des politiques publiques sur les résultats périnatals en France. Santé, Société et Solidarité 3 (1): 57–68.

    Article  Google Scholar 

  • Sage-Pranchère, N. 2007. Mettre au monde: Sages-femmes et accouchées en Corrèze au XIXe siècle, Vol. 1. Archives départementales de la Corrèze.

  • Sage-Pranchère, N. 2017. L’école des sages-femmes. Naissance d’un corps professionnel (1786–1917). Tours: Presses Universitaires Francois-Rabelais.

  • Saillant, F., and O’Neill M. 1987. Accoucher autrement. Repères historiques, sociaux et culturels de la grossesse et de l’accouchement au Québec. Montréal: Les Éditions Saint-Martin.

  • Simonds, W., B.K. Rothman, and B.M. Norman. 2007. Laboring on: Birth in transition in the United States. Abingdon: Taylor and Francis.

    Google Scholar 

  • Statistics Canada. 2016. Annual demographic estimates: Canada, provinces and territories, Canadian socioeconomic database, table 051-0004 and Catalogue no. 91-215-X.

  • Strong, P.M. 1979. Sociological imperialism and the profession of medicine A critical examination of the thesis of medical imperialism. Social Science and Medicine Part A 13: 199–215.

    Article  Google Scholar 

  • Ten Hoope-Bender, P. 1997. The demedicalization of childbirth. World Health 50 (2): 6–7.

    Google Scholar 

  • Torres, J.M. 2014. Medicalizing to demedicalize: Lactation consultants and the (de) medicalization of breastfeeding. Social Science and Medicine 100: 159–166.

    Article  Google Scholar 

  • Utz, B., and A. Halim. 2015. Improving midwifery care worldwide. The Lancet 385 (9962): 26–27.

    Article  Google Scholar 

  • Valentini, H. 2004. «Notre force de changement » –L’évolution de la périnatalité au Québec–1973-2003. Santé, Société et Solidarité 3 (1): 49–55.

    Article  Google Scholar 

  • Walsh, D. 2007. A birth center’s encounters with discourses of childbirth: How resistance led to innovation. Sociology of Health & Illness 29 (2): 32–216.

    Article  Google Scholar 

  • Walsh, D. 2010. Childbirth embodiment: Problematic aspects of current Understandings. Sociology of Health & Illness 32 (3): 486–501.

    Article  Google Scholar 

  • Williams, S., and M. Calnan. 1996. The ‘limits’ of medicalization?: Modern medicine and the lay populace in ‘late’ modernity. Social Science and Medicine 42 (12): 1609–1620.

    Article  Google Scholar 

  • Williams, S.J., C. Coveney, and J. Gabe. 2017. The concept of medicalisation reassessed: A response to Joan Busfield. Sociology of Health & Illness 39 (5): 775–780.

    Article  Google Scholar 

  • Whitfield, A. 1992. A short history of obstetric anesthesia. Res Medica 3 (1): 28–30.

    Google Scholar 

  • World Health Organisation. 1985. Appropriate technology for birth. The Lancet 2: 7–436.

    Google Scholar 

  • World Health Organisation. 2007. Normative guidelines on pain management. Report of a Delphi Study to determine the need for guidelines and to identify the number and topics of guidelines that should be developed by WHO. Report prepared by Prof Neeta Kumar. Geneva: WHO.

  • Zola, I.K. 1972. Medicine as an institution of social control. The sociological review 20 (4): 487–504.

    Article  Google Scholar 

Download references

Acknowledgements

I would like to warmly thank the two anonymous reviewers and editors of Social Theory & Health for their excellent comments and suggestions, which contributed greatly to the improvement of this manuscript. I also would like to gratefully acknowledge Stephanie Alexander, Tarik Benmarhnia and Anne Lucas for their careful proofreadings and their precious help.

Author information

Authors and Affiliations

  1. EHESS, School for Advanced Studies in the Social Sciences, 54 Boulevard Raspail, 75006, Paris, France

    Maud Arnal

  2. CERMES 3, Medicine, Science, Health and Society, 7, Rue Guy Môquet, 94800, Villejuif, France

    Maud Arnal

  3. IRIS, Interdisciplinary Institute of Social Issues, Campus Condorcet, Bâtiment Recherche Sud, 5 cours des Humanités, 93322, Aubervilliers, France

    Maud Arnal

Authors
  1. Maud Arnal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maud Arnal.

Ethics declarations

Funding

The research leading to this publication has received funding from the EHESS PhD fellowship and the LabEX TEPSIS mobility fellowship, which I thank for their support.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Arnal, M. The transformations of medicalization of pain relief in the organization of perinatal care system in Quebec. Soc Theory Health 19, 220–245 (2021). https://doi.org/10.1057/s41285-020-00133-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/s41285-020-00133-1

Keywords

  • Pain
  • Childbirth
  • Medicalization
  • Women
  • Health systems
  • Healthcare organization