‘polluting’.[53,68–71] From this patriarchal point of view, pregnancy and birth were viewed as inherently imperfect, ‘pathological’, ‘abnormal’ and ‘unnatural’, and ‘untrustworthy mechanical processes’ [72] that could and should be controlled.[52,73] Thebiomedical and technocratic discourse altered the role and status ofMNCprofessionals. Midwives’ knowledge and practice were increasingly disputed and devalued, and they were often accused of witchcraft.[53,67,74] Neonatology claimed authority over diseases of the newborn,[75] obstetricians assumed expertise over the pathologies of pregnancy and birth and the use of medical interventions, and midwives were granted the domain of physiological a pregnancy and birth.[50,55,76,77] Furthermore, MNC professionals were now deemed responsible and accountable for their decisions, confirming the belief that risks can be managed and adverse outcomes are the fault of those who made the decisions about care.[52,73] The pre-modern blaming system based in religion and sin was replaced by a secular system of blame.[52,78–80] Within the discourse that views pregnancy and birth as events that require medical management, risk ― a term used predominantly in relation to pathology ― is central in decisions about care provision.[52,73] Rothstein and colleagues (2007) refer to this phenomenon as “risk colonization”,[81] where risk has increasingly come to define the object, methods, and rationale of MNC.[82] This is accompanied by what Scamell and Alaszewski (2012) refer to as “an ever-narrowing window of normality”,[52] where normality is signified only through an absence of risk, and pregnancy and birth can only be labelled as physiological in retrospect.[52,60–62,69] Risk is located inside the body, which can be detected and treated from the outside-in, legitimizing continuous monitoring. [60,83,84] Reynolds (1991) labels this process as the “one-two punch”: punch one is destroying natural processes after rendering them dysfunctional with technology, and punch two is fixing it with technology and rebuilding them as a medical process.[72] The labelling of an increasing number of normal bodily processes as risky is also referred to as ‘medicalization’ or ‘pathologization’. This includes defining morbidity and mortality that result from structural inequalities, such as housing and nutrition, as individual medical conditions that can be treated with medical interventions.[85–88] Paradoxically, the same science, technology, hospitals, and care professionals that monitor, prevent, and treat risks from inside the body, can increase the risks of maternal and perinatal morbidity and mortality.[53,89–92] This is referred to as iatrogenesis.[93] Consider, for instance, the development of the forceps, an advancement in medical technology won at the expense of underprivileged, poor and black women, who were involuntarily experimented upon in horrific circumstances.[94,95] Historians have noted that the development of pain management was likewise built on discriminatory ideas. There was a fear that white upper-class women ― who were thought to be more fragile 25 1 GENERAL INTRODUCTION
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