The relevance of the history of medicine to an understanding of current change: some comments from the domain of antenatal care

Abstract

A historical perspective on antenatal care shows a certain continuity to those aspects of it which are currently considered to be problematic. The problems generally are social ones: in addition to the orthodox function of preventing physical mortality and morbidity medical antenatal care is seen to also exert control over women to determine their place in society and to aggradize obstetrics as a medical specialty. The medical formula has been to treat expectant women as patients with little attention being directed toward the long term social and individual conditions necessary for health and for healthy childbearing. Another shortcoming lies in the enthusiastic introduction of technological innovation into antepartum intrapartum and postpartum care. Much of this technology has not been subjected to controlled testing. What can be done on a practical level to reverse these trends? Certain questions must 1st be answered. We need to know just what if any benefits are derived from present practices in antenatal care and if such benefits are capable of overriding the long and short term effects of social neglect occasioned by these practices. Several steps which can be taken towards humanizing antenatal health care can be identified. Antenatal care could profitably be decentralized from large hospital clinics to smaller community ones. Education of users of the services of antenatal clinics would certainly lead to more informed consumers and hopefully would lead to more concerned care. Finally equalizing the imbalance of unevenly distributed social and economic resources in the community could lead to a more uniformly utilized and equitable antenatal health care system.