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Wallea RossPower, health and Gender.IntroductionThrough the use of theory and a contemporary Australian example, the link between power, health and gender will be examined. Pease (2010) links power to privilege and shows how privileged groups can marginalise others through every day practices, sometimes unknowingly. Connell (1995) will be used to discuss how hegemonic masculinity plays a large part in childbirth and c-sections. Germov (2014) is used to discuss the dominance of the medical model in birthing, despite birthing not needing to take place in hospitals and Thompson (2011) to discuss the medicalisation of childbirth. Through this, ideas will be formed on how to work in an empowering way with women seeking to birth their children using alternative methods.Childbirth and Caesarians Since the 1970s childbirth has predominantly occurred in hospitals.A caesarean section (c-section or caesarean) is a surgical procedure in which a baby is born through an incision (cut) made in the mothers abdominal wall and the wall of the uterus (womb) (Better Health Channel 2014).A caesarian originally was used as a last resort if complications were to arise when giving birth, but now can be elected if there are signs that a vaginal birth is risky (Better Health Channel 2014).Currently, a c-section is the most common surgical procedure in Australia, with a higher rate of mothers seeking treatment in private hospitals than public (Morrison, Rennie & Milton, cited in Ross 2014, slide 34).Despite WHO (World Health Organisation) recommending no more than 10% of women require c-sections, on average 20% of women give birth via c-section, with private hospitals having rates of 40% (Roberts, Tracy & Peat, cited in Ross 2014, slide 35)It can be argued that there is an over perscription of c-sections as there is yet to be sufficient proof to its benefit in non-emergency situations (The Australian Council for Safety and Quality 2004, n.p.).What women wantSome women want control over their childbirth, however, some do not.For some women having control over their childbirth can be a c-section or giving birth in hospital for immediate treatment of any complications that arise. For some women who seek alternative methods, to give birth in a hospital or via c-section would be to give up power over their situation.Some women wish to have access to a midwife or a doula during their pregnancy and childbirth. But due to the dominance of the medical model, it is hard for midwifery to be seen as a safe, knowledgeable profession.Lazarus (2009) writes of the differences between classes of women and what they prefer. Lay middle class women with a broad knowledge of technology and what is available to them were more concerned with how they were to have control throughout the course of their pregnancy and childbirth, and often utilised a physician to help represent their needs. However women of lower socio-economic standing didnt expect or want control, what they wanted was a continuity of care (Lazarus 2009, n.p.). This shows the class differences between women and how it can affect what they want in childbirth.Regardless of personal choice, all women wish to give birth to a happy, healthy child. And in most cases go to a hospital to receive the support and care they need with 0.9% of women in 2010 giving birth outside of a hospital or birthing centre (Homebirth Australia 2014, n.p.Individual experiences and the complexities within the dominant discourseI lost my first child in a ridiculously long 'natural' labor! My next two were born painlessly and HEALTHILY with a c-section. No one should feel pressured one way or the other. I WOULD have chosen a c-section IF [I] had that choice because [I] was inordinately afraid of birthing [], but [I] suffered ridicule and derision for those thoughts ... most important[ly], my two c-section boys are healthy and grown! (Fasano on circleofmoms 2014, n.p.)I had one baby in-hospital with an OB and an attending doula [] I think she helped advocate for my husband and I in the presence of hospital staff, who in most cases just want to get the deed done and don't care how it happens as long as mom and baby are alive at the end [] My view from the hospital bed, was that hospital staff were kind, but very intrusive. The monitor was a giant pain, and the nurse was only worried about getting that monitor info for the doctor, who waltzed in at the last minute and broke my daughter's collarbone pulling her out, not to mention tearing the heck out of my you-know-what. I wasn't really impressed with the whole experience of in-hospital. [] I had my second child at home, in the comfort of my own surroundings. Even my dog laid by my side as I labored to comfort me. I had my own hot shower, no one bugging me, and called the midwife when I felt I was ready. As it turns out, I was in hard labor, and she arrived within minutes of me delivering another healthy baby girl. (Hartman on circleofmoms 2014, n.p.)The link between inequality and privilegePease (2010, p. 2) theorises about privilege and power, especially how it can be invisible to those who do and do not have it. In the context of childbirth, Peases theory shows the pattern of the privileged group using their power to dominate and control pregnant women.It can be argued that originally women as a social group had ultimate power and control over their own pregnancy.Through the dominance of the medical model and the masculinity of health and childbirth (Cahill 2001, p. 334), the majority of women in the Western world have lost the ability to have the ultimate knowledge of their situation. This helps to reinforce the status quo of doctors medical knowledge being the correct way to treat and handle pregnancy.However, instead of focusing on the subordinated (women) it is important to focus on the dominant group (men and some women) to bring about change (Pease 2010, p. 2)Doctors role in childbirthOdent (2009) notes a large shift in birthing occurring in the mid 20th century, as more doctors were given specialised training in such areas as obstetrics and gynecology, and these doctors were predominantly male. Due to this, he writes, the masculisation of child birth began and continued to grow to this day (Odent 2009, p. 185)Doctors play a key role in child birth, from the initial pregnancy test, right up to labor and delivery.Doctors have vested interest in child birth, as in the USA during 2011 obstetricians earned a mean income of $220, 000, with men earning 14% more than women in the same role (Medscape 2012).Due to the dominance of the medical model, doctors are seen as pivotal to the health and wellbeing of women and their fetus in contemporary society. For example, when looking up online what to do when you find out youre pregnant, the first step is generally to find a doctor (often named the caregiver) as they are to give you knowledge and help for the pregnancy. (Baby Center 2014).It can be argued that the power and privilege of the dominant group (doctors, policy makers, allied health) results in domination over womens bodies by reducing their experience of childbirth to a well practiced routine. This is shown most clearly through the use of c-sections when medical intervention is not necessary.As Ross (2014, slide 49) writes, current Australian health policy and medical insurance schemes, such as Medicare, recognises only specialist obstetricians and general practitioners as providers of primary maternity care. Due to this, there is no space for alternative care to be received through Medicare, which purely benefits the medical model and the health practitioners receiving work.

The government sets the dominant discourseThe government is a key player when it comes to maternity care and how its delivered.Womens health care needs in relation to their pregnancy have become a large part of the governments political agenda (Reiger 2006, p. 330).Politics is about compromise, as major parties must find common ground to get changes through the senate. This means that the policy arising from such compromise can serve a larger political agenda rather than the interests of the consumer (Belcher 2014, p. 360).An example of this is maternity leave, which is enforced by the government. With each budget comes differing maternity leave policy based on budget and political views. This year Prime Minister Tony Abbott pushed for higher paid parental leave (Griffiths 2014, n.p.).Medical modelThe biomedical model is an approach to health care which perpetuates the dominant discourse. It involves a view of the body as a machine, and illness as faulty parts that must be repaired or replaced. (Germov 2014, p. 11)The biomedical model tends to reduce its focus on disease to the biological level, through this, the social and psychological aspects of illness are ignored or downplayed. (Germov 2014, p. 13)As a result the social determinants of health are not taken into account and factors directly linked to them are reduced to biological reasoning. The issue with this being biological determinism, where peoples biology causes or determines their inferior social, economic and health status. (Germov 2014, p. 13)the medicalisation of child birthIn the medical model, health is presented primarily as an absence of disease (Thompson 2011, p. 124)If this is the case, what place does childbirth have in hospitals and with doctors?The mecicalisation of society comes from the fact that the medical model is so strong that it is generally taken for granted as the way of conceptualising health and illness (Thompson 2011, p. 126) and, as Illich writes, iatrogenic medicine reinforces a morbid society in which social control of the population by the medical system turns into a principal economic activity. (cited in Thompson 2011, p. 128). Through this power is transferred to one dominant group, in this case, doctors and other health professionals. Not only that, but it has the effect of depoliticising issues of social discord, distress and deviance. (Thompson 2011, p. 128)Using Thompson helps to reveal the close link between health and politics, showing how the dominance of the medical model helps to perpetuate the status quo of the dominant group.The medicalisation of childbirth began alongside the shift to giving birth in hospital in the 70s, giving power to the medical model.Through this women are positioned as needful of constant self-surveillance and medical surveillance (Ross 2014, slide 34), despite the dominant discourse leaving them with little choice but to buy into the medicalisation of their own childbirth.This can be linked to Foucaults panopticon (cited in Germov 2014, p. 24) where he theorises that control can be maintained over people who feel they are under constant surveillance. Other determinants of child birthing methodsChildbirth is becoming increasingly political as there is constantly a need for better maternity care at a policy level which places pressure on health budgets.Alongside social and political determinants of the increasing use of caesarian sections in child birth, there are also economic factors.Economically, it can appears that women who are more financially viable, and who have private health care, are more inclined to receive a caesarian.There is a positive correlation between private health insurance and c-sections (Ross 2014, slide 40) and arguably class.Interestingly, it may not be in middle class womens health interests to respond to the normalising of birth by caesareans the question could be asked: who most gains from this practice?Inequality occurs when women with more money have access to better health care and elective c-sections where the same might not be available to women of lower socio-economic standing.Why is this a health issue?Childbirth in contemporary Australia is a health issue for two main reasons:Firstly, the rate of unnecessary c-sections shows a broad pattern of women not having ultimate control over their pregnancy, and perhaps can be linked to the dominance of the medical model subordinating those wanting alternative birthing.Secondly, western countries with the lowest obstetric intervention rates have lower rates of morbidity and mortality in relation to pregnancy (Enkin, Kierse, Neilson, Crowther, Duley, Hodnett & Hofmeyr, cited in Ross 2014, slide 38) so it can be argued that higher rates of morbidity and mortality are due to over interaction with obstetricians and other health professionals, for example, getting a c-section without there being medical need.These two examples show that taking control from women giving birth and increasing medical contact is a health issue affecting women and childrens safety, wellbeing and sense of empowerment.See following slidesPhysical Complications arising from c-sectionsThe Mayo Clinic (2014) list the following as risks that can occur from c-sections:For babies:Breathing problems (transient tachypnea & respiratory distress syndrome) For the mother: Inflammation and infection of the membrane lining the uterusIncreased bleedingReactions to anesthesia Blood clotsWound infectionSurgical injury (to nearby organs such as the bladder)Increased risk during future pregnanciesSakala (2014) discusses further complications:Hysterectomy Risk of re-hospitalisation Low future fertilityRisk of baby growing in the scar tissue left by c-sectionProblems with placentaScar in the uterus likely to open in future pregnancyFuture babies are more likely to die before or just after birthFuture babies at higher risk of having physical abnormalities, injury to their brains and spinal cords

Emotional complicationsUdy (2009) lists the emotional experience of childbirth as:A sense of loss: birth didnt turn out like expected, loss of the experience of participating in the birth experience, not being there when the baby enters the world Interrupted relationship with baby: feelings of detachment from her baby Altered identity: sense of failure, feminine identity altered; lowered confidence in her body Intimations of mortality: surgery gives rise to fears about mortality Feelings of violation: from surgery where the body boundaries are violated, feeling mutilated or butchered Anger at caregivers: particularly regarding what was perceived to be an unnecessary cesarean, lack of involvement in medical decisions, feeling unsupported by hospital staff before, during and after the cesarean Dissociation: feeling that the surgery was taking place on someone else or from a distance Humiliation: being scolded Helplessness: not being able to take care of herself or her baby Posttraumatic Stress Disorder symptoms: anxiety, trouble sleeping, panic attacks.Connell and hegemony of childbirthThe over use of c-sections in Australia, and the medicalisation of childbirth, can be explained using Connells theory of hegemonic masculinity.Hegemonic masculinity can be defined as the configuration of gender practice which embodies the currently accepted answer to the problem of the legitimacy of patriarchy, which guarantees (or is taken to guarantee) the dominant position of men and the subordination of women. (Connell 1995, p. 77)Through Connells understanding of hegemonic masculinity, and the use of Peases (2010) theory of privilege and power, it can be said that due to hegemonic masculinity and patriarchy, the dominant group (men, the medical model and some women) subordinate, dominate and control women in order to keep the status quo (Davis-Floyd & Sargent 1997).LeMoncheck discusses how in both law and medicine men have used their power to define reproduction as a biological defect (LeMoncheck, cited in Cahill 2001), which further shows how the dominant group maintains control by assuming ultimate authority.The medical model perpetuates the medicalisation and masculisation of childbirth, as Cahill writes, male justifications of female inferiority have been developed and nurtured through professional discourses and socialization processes inherent within medical education and practice (cited in Cahill 2001).

ContThe largest social determinant within childbirth is gender, with women being subordinated by men in an area in which they have more experience, as men cannot bare children. As Cahill writes, maternity care is a key area in which womens ability to exercise real choice and make informed decisions is limited and where doctorpatient interactions are themselves constructions of existing gender orders; womens autonomy continues to be violated through both quite subtle and overt discourse and practice. (Cahill 2001, p. 334). This helps to show the social constructedness of health (Thompson 2011, p. 121), despite the medical model not recognising it.Finally, LoCicero discusses the gender-inappropriate elements of the medical model, stating that they probably contribute to the excessive rates of interventions in labor and that the present model of obstetric services is consistent with a masculine style, and offers far less than optimal care for women. (LoCicero 1993, p. 1261)How to empower womenIn order to address this health issue, not only do we need to focus on ways to change policy and the dominance of the medical model, we need to find better ways to empower women.Due to the dominance of the medical model, midwifery has become subordinated (Fahy, 2007). Midwifery can be used as a way to better empower women in their childbirth.A good example of how women have been empowered in childbirth is Indigenous Birthing in New Zealand where publicly funded midwifery has been available for over 10 years. Through this lower rates of perinatal mortality have been achieved. Not only that, but in whole Maori women are more empowered and there were reduced health care costs. (New Zealand Ministry of Health, cited in Ross 2014).A way to work with, and empower women is to:Provide better education on the risks of c-sectionsProvide more information of alternatives to birthing in hospitalsGive more government funded choices, such as the use of midwifesHave more spaces where women can discuss their experiences and broaden their knowledge of what is best for their personal situationEncourage activism to influence policy and government budgets

conclusionThe dominance of the medical model has both positively and negatively shaped the way women give birthUsing the theorising of Pease (2010), Thompson (2011) and Connell (1995) and applying it to the rise of c-sections in Australia and western society it can be argued that caesareans are being used as a tool of domination and control by (some) men and (some) women over women.The rate of c-sections is a health issue as there are many complications arising from the procedure. Although it must be said that there is a time and a place for intervention in childbirth.In order to give power back to women more power must be given to midwifes and alternative health. As shown in New Zealand, lower c-sections with relevant supports for mothers and babies leads to lower mortality rates.AppendixCaesarian a surgical child birthing practice where the baby is born through an incision in the mothers abdominal wall and uterus (Better Health Channel 2014)

Empowerment - a cognitive state characterized by a sense of perceived control, perceptions of competence, and internalization of the goals and objectives of the organization (Menon 1999)

Gender the socially constructed categories of feminine and masculine and the social power relations based on those categories, as distinct from the categories of biological sex (Germov 2014, p. 512)

Health being free from illness or injury (Germov 2014, p. 11) and also comprising of other social factors such as: emotional, mental, physical wellbeing, cultural and economical.

Hegemonic masculinity - the configuration of gender practice which embodies the currently accepted answer to the problem of the legitimacy of patriarchy, which guarantees (or is taken to guarantee) the dominant position of men and the subordination of women. (Connell 1995, p. 77)

Inequality - the unfair distribution of, and ability to access, resources (Walker 2014, n.p.).

Medical model the conventional approach to medicine in Western societies, based on the diagnosis and explanation of illness as a malfunction of the bodys biological mechanisms (Germov 2014, p. 11).

Power the ability to influence or control people, events, processes or resources (Thompson 2011, p. 55)

Privilege when one social group has something that another social group cannot attain due to being a part of that social group, as opposed to failing to do something to gain it (Pease 2010).

ReferencesBaby Center 2014, Im Pregnant: now what?, viewed on 2 October 2014, < http://www.babycenter.com/pregnant-now-what Belcher, H 2014, Power, politics and health care in J Germov (ed.), Second opinion: an intro to health sociology, 5th ed, Oxford University Press, South Melbourne, pp. 359-387.Better Health Channel 2014, Caesarean Section, viewed on 2 October 2014, < http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Caesarean_section >Cahill, H 2001, Male appropriation and medicalization of childbirth: an historical analysis, Journal of Advanced Nursing, vol. 33, issue. 3, pp. 334-342).Circle of Moms 2014, Did you choose a natural birth or medicated? Would you do the same again?, viewed on 2 October 2014, < http://www.circleofmoms.com/question/did-you-choose-natural-birth-medicated-would-you-do-same-again-1700791 >Connell, R 1995, Masculinities, University of California Press, Berkeley. Davis-Floyd, R & Sargent, C (Eds) 1997, Childbirth and Authoritative Knowledge: cross-cultural perspectives, University of California Press, Berkeley.

References contFahy, K 2007, An Australian history of subordination of midwifery, Women and Birth, vol. 20, issue. 3, p. 141.Germov, J (ed.) 2014, Second opinion: an intro to health sociology, 5th ed, Oxford University Press, South Melbourne. Griffiths, E 2014, Paid parental leave: Tony Abbott reduces threshold from $150,000 to $100,000, viewed 2 October 2014, < http://www.abc.net.au/news/2014-04-30/tony-abbott-reduces-maximum-ppl-payment/5419878 >Homebirth Australia 2014, Australian Homebirth Statistics, viewed on 2 October 2014, < http://homebirthaustralia.org/statistics >Lazarus, E 2009, What do women want?: issues of choice, control, and class in pregnancy and childbirth, Medical Anthropology Quaterly, vol. 8, issue. 1, pp. 24-46.LoCicero, A 1993, Explaining excessive rates of cesareans and other childbirth interventions: contributions from contemporary theories of gender and psychosocial development, Social Science and Medicine, vol. 37, issue. 10, pp. 1261-1269.Mayo Clinic 2014, Risks, viewed on 2 October 2014, < http://www.mayoclinic.org/tests-procedures/c-section/basics/risks/prc-20014571 >

References contMenon, T 1999, Psychological empowerment: definition, measurement, and validation, Canadian Journal of Behavioural Science, vol. 31, issue 3Reiger, K 2006, A neoliberal quickstep: contradictions in Australian maternity policy, Health Sociology Review: childbirth, politics and the culture of risk, vol. 15, pp. 330-340.Ross, D 2014, Gender and Health, SCS285 Health, Society and Culture lecture notes, week 5, USC.Sakala, C 2014, What You Need to Know About Cesarean Section: an Interview with Dr. Carol Sakala of Childbirth Connection, viewed on 2 October 2014, < http://www.hmhb.org/virtual-library/interviews-with-experts/cesarean-section-c-section/ >Thompson, N 2011, Promoting equality: working with diversity and difference, 3rd ed, Palgrave Macmillan, London.Udy, P 2009, Emotional Impact of Caesareans, Midwifery Today, issue. 89Walker, C 2014, New dimensions of social inequality: why social inequality?, viewed on 19 September 2014, .