A social or medical model of childbirth? : comparing the arguments in Grampian (Scotland) and the Netherlands
This study explored the differences between the organisation of maternity care in Britain and the Netherlands. The debates within each national system between proponents of high-technology obstetric hospitals and those of low-technology maternity care were analysed. This specific comparison was approached through a qualitative analysis and a quantitative content analysis. In the Netherlands I analysed the debate between home and hospital-birth supporters in a medical journal in 1986-1987 and in Scotland I analysed the replies to Grampian Health Board's proposals to close peripheral maternity units in 1987-1988. At a theoretical level the distinction is made between 'medical' and 'social' model of childbirth. Three levels of approaching the differences between these two models were unravelled in order to come to a better understanding of reality. One of the central points is question of risk in childbirth, which is the dividing factor between models of childbirth. The concepts of 'patriarchy' and 'medicalisation' are rejected as possible explanations for the differences between the Dutch and British organisation of maternity care. I explore the possibility of Jamous and Peloille's I/T ratio as an explanatory tool, and suggest a minor adaptation to this theory. Furthermore, in order to incorporate the state intervention in the interprofessional competition between midwives and doctors I suggest that Abbott's theory of 'systems of professions' could bring some light on the question. Finally, I suggest as a policy conclusion that a risk selection list similarly to the one in existence in the Netherlands should be drawn up in Britain. However, such a list should not be drawn up by obstetricans only or even a committee wherein obstetricians form a majority. I argue that a committee for the drawing up of national selection criteria should include representatives from midwives, health visitors and consumers.