Proefschrift

Althoughwomen-centred care has received increasing attentionover the past decade,[122] it is not yet routine care.[123–125] A women-centred approach is important because women perceive risk differently than midwives and obstetricians.[23,33,71,126–133] Women may prioritize risks in ways different than professionals. They may, for example, be willing to accept risks to themselves and their children and may consider not just physical risk, but psychological, social, cultural, and spiritual risks as well.[134–136] The difference in perspective between women and professionals is believed to result from diversity in focus rather than concern. Women are more likely to localize and contextualize risks within their life circumstances, whereas professionals view them as isolated medical issues. According to the philosopher Michel Foucault, professionals interpret patients’ needs through a biomedical gaze.[137,138] As such, women’s decisions that do not align with the biomedical discourse aremore likely to be considered as irrational by professionals. [23,98] Studies indicate that care professionals are supportive of women’s decisions to a certain extent.[131] For example, some professionals believe that the needs of women may be overridden for the safety of the foetus.[139] According to Stone’s analysis of risk construction in MNC (2021), care is guided by biomedical risk discourses instead of the relationship between the mother and the child. This conceptual separation of mother and child is a consequence of the Cartesian doctrine of mind-body separation,[140] and is supported by increasingmedical and technical possibilities tomonitor the foetus.[131,141] Professionals make negative judgements of women as mothers based on concerns over foetal wellbeing, calling on and reinforcing the norms of self-sacrificial motherhood dominant in the biomedical discourse in contemporary MNC.[131] The result is the exclusion of women’s inner knowledge and authority in decision making.[27,142,143] Studies have described professionals’ beliefs that they, and not women, are the foetus’ best advocate.[131,139] The foetus-centred and patriarchal focus trivializes women’s experiences, and suggests that women’s lives have only contingent value.[131,144] Oakley (1984) and Wagner (1994) argue that this perspective reduces women to “captured wombs”, and “birthing machines” rather than individuals in their own right.[145–148] This conflict between a woman’s autonomy and her care professionals’ judgement about the child’s interests is often described as “maternal-foetal conflict”, putting the woman against her foetus.[131,148] A study by Jenkinson and colleagues (2017) illustrates what happens if women decline recommended care, revealing the politics and power relations of MNC.[143,149] Women report that, once they cross the line of what professionals consider the ‘right’ decision, they experience disrespectful care, assault, badgering, punishment, judgement,[131] and even coercion by emphasizing the risks to the foetus.[45,131,139] This may lead to violent, 167 7 GENERAL DISCUSSION

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