McDonaldization of Childbirth
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Traditionally, childbirth has emphasized the joy of bringing a new life into the world. However, with the McDonaldization of healthcare, childbirth seems to be more about standardization over nature. Hospitals have begun to copy procedural ideas of major corporations and childbirth has begun to be centred on efficiency, predictability and control.
To generate more money, hospitals have placed focus on efficiency, taking a woman through childbirth as quickly as possible. As a result, standard, predictable procedures are necessary. Technology is being used at an increasing rate, acting as a control over the natural process of childbirth. Overall, it seems that selling the idea of care is more important than the care itself.
Throughout efficiency, predictability and control, there is the idea of ?irrationality of rationality.? According to Ritzer, ?many of these irrationalities involve the opposite of the basic principles of McDonaldization,? (269) with the basic principles being efficiency, predictability and control. This aspect of the McDonaldization thesis will be discussed in conjunction with the basic principles.
Efficiency Efficiency is the effort to discover the best possible means to whatever end is desired. (Ritzer: 268) In other words, efficiency is the quickest route from point A to point B. For childbirth, it is the quickest delivery with the least amount of pain.
Hospitals have increased their efficiency by shortening stays after delivery, as well as by increasing their usage of medical interventions. Medical interventions include induced labours, epidurals, and caesarean sections. This move to efficiency has created a new social phenomenon that has been dubbed ?too-posh-to-push.? ?Too-posh-to-push? has resulted because more and more women are asking for the use of medical intervention. They want to have a baby, but they don?t want to go through the natural delivery nor do they want to stay in the hospital to recover.
Medical interventions are on a rise, but in-hospital recovery is in a serious decline. More women are opting for inducing labour and using epidurals, which put both mother and child at a higher risk, but hospital are sending them home earlier than they would have been even a decade ago. Before women used to stay, on average, 4 days after delivery, now they stay 1 or 2 days at most. With mother and child now having to face post-partum complications at home, emergency rooms have to pick up the slack of the maternity wards.
Medical interventions are also leading to increasing the risks for the baby. More babies are being admitted to the neonatal intensive care unit (NICU) to be placed in an incubator. Medical interventions increase the risk of babies being underweight, premature, and having birth defects, although it must be noted that medical interventions are not the sole cause. Babies tend to remain in NICU for an average stay of 2 days, which could have been prevented if medical interventions were not used. That is not to say there are no cases that intervention is not need, but these do not make up the majority.
The irrationality of rationality, or in this case the inefficiency of efficiency is that women are going through the delivery process faster, but at a higher risk of complications to both mother and child.
Predictability Predictability is acting in a way that is repetitive and standard. With regards to McDonalds, ?employees are expected to perform their work in a predictable manner, and customers are expected to respond with similarly predictable behaviour.? (Ritzer: 268-269) Childbirth conforms to this idea of predictability by having standardized procedures for handling the delivery of babies, even in low-risk cases.
Regardless of age and ethnicity women go through standard procedures in childbirth. This not only make childbirth predictable amongst women in one hospital, it makes it predictable over a province or territory, and over the entire country. However, there are difference amongst the individual provinces and territories.
Increasing predictability for expectant mothers, it caesarean sections. More and more often women are opting to deliver by caesarean sections even when there is no risk that would deem one necessary. Caesarean sections have enabled women to choose when their baby will be born, making delivery even more predictable. It increases the predictability of procedures and it takes the guesswork out of wondering when the baby is going to ?come.? The unpredictability of predictability with regards to the procedures is that there are a variety of situations that could arise that it is impossible to have procedures in place to handle them. Every woman labours and delivers differently with each birth she goes through. No two birthing experiences are ever the same; it?s nature?s way of ensuring each baby a unique entrance to life. Depending on age and ethnicity, risk factors for complications differ, which these standard procedures do not take into account. No matter how predictable hospitals make childbirth procedures, childbirth itself will always be unpredictable.
With regards to choosing a caesarean section date making childbirth predictable, the unpredictability of it is that circumstances arise that can change the date. Moreover, situations can arise that cause the woman to change her mind to not wanting a caesarean section birth. Although opting for caesarean sections can make the delivery date predictable, there are still variables that could change, and as a result cause a change in the predictable date.
Control ?There is a great deal of control in a McDonaldizing society, and a good deal of that control comes from technologies. While these technologies currently dominate employees, increasingly they will be replacing humans.? (Ritzer: 269) At an increasing rate obstetricians are using non-human technologies during the childbirth process.
The major technology used is the scalpel. Although basic and not exactly what a person would think of as being technology, it the most widely used technology in childbirth. Even 10 or 20 years ago it was being used widely during childbirth. The scalpel is used to perform episiotomies, which is a surgical cut to prevent vaginal tearing and other post-natal complications.? (Ubelacker, 2004) Episiotomies have been used for years; however they are on a decline, as caesarean sections increase in usage. The scalpel is also the key tool used in caesarean sections. The scalpel has remained one of the most widely used non-human technologies in childbirth.
Forceps are also a non-human technology used in childbirth. They are used to ?assist? the baby out of the uterus. Although the use of forceps is declining, there is a new technology replacing it, vacuum extraction. Vacuum extraction involves placing a suction cup on the baby?s head to help ease the baby into the world. This new technology is being used at an increasing rate.
The non-control of control is that there?s always a chance of technology failing, breaking down, or being used incorrectly. The main concern should lie with vacuum extraction. Any slight change in any one variable with vacuum extraction can cause serious damage. Using it incorrectly poses a very high risk of damage. The same goes with the scalpel, it is a knife, and with one wrong move irreversible damage can be caused. If the person using the scalpel does not know how to use it correctly, there is a high potential of serious risk, damage, injury, and death. The non-control is that technology in childbirth can fail or breakdown or be used incorrectly, and the potential results can be serious.
Summary Childbirth once emphasized the joy of new life being brought into the world, however, with the McDonaldization of society, healthcare in particular, it seems to focus more on efficiency, predictability, and control. Through medical interventions and shorter hospital stays childbirth is supposed to be more efficient, but it becomes inefficient due to the higher risks involved. Doctors, to increase the predictability of labour and delivery, invented standard procedures for childbirth. Childbirth due to nature is unpredictable, because labour and delivery is different for every woman and every baby. Non-human technologies are supposed to lead to a greater amount of control within childbirth, however, with the technologies being unpredictable themselves, they make childbirth uncontrollable. Overall, selling the idea of care seems more important that the care itself.
Conclusion In the McDonaldization theory there is one other concept, calculability. Calculability places an emphasis on quantity over quality. (Ritzer: 268) Although the quality of care received during childbirth is questionable, the emphasis is not on how many babies are born. However, Ritzer does point out there is a scoring system once the child is born.
Once the baby comes into the world, there is a calculable scoring system, Apgar, used on newborns. The babies are given scores of 1 to 2 on five factors (for example, heart rate, colour), with 10 being the top (healthiest) total score. Most babies have scores between 7 and 9 a minute after birth, and 8 to 10 after five minutes. Babies with scores of 0 to 3 are in distress. (Ritzer: 274-275) Overall, the healthcare system has allowed itself to be McDonaldized and mothers-to-be have helped to keep McDonaldization with childbirth. By adopting procedural ideas from corporations, healthcare has become efficient, predictable, and controllable, but at a cost of increased risks, which have lead to inefficiencies, unpredictability, and uncontrollability within medicine. Mothers-to-be have helped to keep it by voluntarily opting for medical interventions, mainly caesarean sections, during childbirth, which has created a social phenomenon called too-posh-to-push. If every woman would opt to labour and delivery their child without medical interventions, the risks of complications would decrease dramatically and babies would be born healthier.
Munro, Margaret. ?Birth Interventions On Rise As ?Too-Posh-To-Push? Phenomenon Grows.? CanWest News. Don Mills, Ontario. September 10, 2004.
Ritzer, George. ?The McDonaldization Thesis: Is Expansion Inevitable.? Society In Question. Toronto, Ontario. 2004. Pages 267-279.
Staples, Sarah. ?Rate of Canadian C-sections at a Record High but New Moms? Hospital Stays Getting Shorter.? CanWest News. Don Mills, Ontario. April 21, 2004.
Ubelacker, Sheryl. ?Health Information Report Shows Changing Picture of Childbirth in Canada.? Canadian Press NewsWire. Toronto, Ontario. September 9, 2004 Essay submitted by Candice Bailey