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.
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“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).
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).
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).
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.
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).
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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.
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.
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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
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