Models of care and physiological childbirth in the Western world: why is health care in childbirth (also in the Czech Republic) culturally conditioned?
Abstract
Respectful supportive care during labour is a powerful factor in achieving optimal outcomes for mother and baby. A growing body of evidence suggests that birth is safer in most cases when normal physiology is supported and when a woman has the opportunity for emotional support through attendants, family, friends and health professionals she trusts.
Although some still assume that the care of the pregnant and birthing woman should be primarily technocratic because more technology means more safety, there is a growing awareness that the reality is much more complex. Technologies such as caesarean section or induction of labour are undoubtedly vital innovations that save many lives each year.
On the other hand, their routine overuse is proving costly to the health system and detrimental to maternal and child health outcomes. Anthropological research shows that even within the so-called Western biomedical paradigm, there are huge differences in obstetric care between societies or communities based on fundamental differences in values and beliefs.
The forms of childbirth are everywhere shaped by cultural, political and economic interests. Even in the Czech context, there are huge differences in the provision of care between different maternity hospitals.
If the practice there were unbiased, objective and based strictly on scientific evidence, the practices and procedures in all maternity hospitals would be similar and would support normal birth physiology. Although the Czech obstetric system ranks among the best health care systems in the world for some of its obstetric outcomes, particularly its neonatal mortality outcomes, voices are increasingly heard in professional discourse pointing to deficiencies in the care of so-called normal or physiologically labouring women.
In our view, for good outcomes of care around childbirth overall, it is necessary to address the cultural aspects of care delivery as well as the aspects of communication between care providers and women, between health professionals and with each other, the values they profess and their understanding of each other.