"Irresponsible" Childbirth or Contravention of Russian Midwifery’s Norms in Homebirth Cases

Abstract

This paper is devoted to the analysis of social norms, transmitted through the Russian obstetrics system, which regulate the behaviour of pregnant women and women in childbirth. Norms are studied as expectations on the part of medical professions on what is “correct” or“appropriate” behaviour, which are prevalent in a given social context. We apply the approach of social constructivism and examine norms through the lenses of parental responsibility, which is seen as a form of compliance with the formal rules and social order of the medical institution examined in this study. Based on materials gathered from focused interviews with obstetricians and participant observation in an antenatal clinic, three levels of women’s responsibility are reconstructed, these being moral, institutional and pragmatic.

Moral responsibility is seen by doctors as an obligatory part of motherhood for women and as a conscious attitude for pregnant women to adopt to their health and its treatment. This implies that pregnant women are expected to weigh all the risks involved and follow the consultations of qualified medical advice. As a consequence, pregnant women are socially constructed as patients and are supposed to attend medical institutions. In this context the institutional level of women’s responsibility is activated, which can be described as the “career of pregnancy”. The normative trajectory of pregnant women prescribes implementation of all the health system’s demands and acceptance of the doctor’s authority. Such a situation leads to the partial loss of the patient’s independence. Moreover, medical personnel devolve pragmatic responsibility to pregnant women and women in labour, defining this as achieving conflict-free communication and winning their willingness to invest more financial and organizational resources into childbirth.

Our results show that homebirth cases tend to fit in with the demands inherent to the moral norms of obstetrics. Those parents choosing this strategy reproduce the model of being a ‘liberal subject’. Nevertheless, medical professionals often define childbirth outside of a clinic as “irresponsible”, as it fails to conform to doctors’ expectations in the institutional and pragmatic levels. Breaches of the institutional and pragmatic responsibilities of women are more keenly sensed by medical institutions due to their organization, which has inherited the structure and form of the Soviet health system, with its strong hierarchical relations and bureaucratized logic used in financing decisions.