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Arnal Maud

Midwife, PhD student in Sociology, EHESS

Postgraduate program: Sociology, specializing in Health, Population and Social Policies

Contact: mml.arnal(at)gmail.com


Dissertation title: The pains of birthing: A public-health issue through the lens of social gender relations

Under the joint supervision of Marc Bessin (Iris) and Ilana Löwy (Cermes3)

The treatment of women’s labor pains in France has been based since the 1970s on a form medical treatment that has gradually become massive. Today, this treatment is circumscribed under analgesia and epidural anesthesia techniques. The rationales underpinning this relatively homogeneous treatment (used for more than 80% of childbirths in France in 2013) raise multiple social, political, and medical tensions. All medical recommendations agree on the need to treat labor pains, but 80% of childbirths are considered physiological. What are the current issues at stake in these forms of treatment of pain? In France, the perinatal field is opening up to a diversification of the treatment supply by authorizing the experimentation of birth centers (2013). These reorganizations of medicalized childbirth places have led to a diversity of forms of treatment of women’s labor pains ranging between two extremes (from maternities catering to a high level of obstetrical risk to the experimentation of birth centers in France where epidural-analgesia techniques are not available). How is the treatment of pain negotiated in these various birthing places? At the margins of medical recommendations, the prospect of categorizing non-dangerous pains for women has led to redefining the contours of pain between normal and pathological. Nevertheless, the different forms of treatment of labor pains raise tensions between biological naturalism regarding the capacity of women to give birth on their own, with no techniques, and the uselessness of these dangerous pains, supported by medical rationalism. How is the responsibility for managing these pains within the couple and among health professionals supported by a biological or social definition of the value attributed to labor pains? Three issues are at stake in the treatment of women’s labor pains: the organization of health policies, the pain-treatment practices of health professionals, and the influence of social gender relations when the work involved in pain treatment shakes up male and female gender attributions. The goal of this research is to analyze the issues jointly at stake in these policy, professional, and family reconfigurations in the perinatal field on the basis of a qualitative analysis (observations and interviews) and a quantitative one (questionnaires) of the theoretical and practical ambivalences raised by the massive medical treatment of these pains. We will focus our attention on the implications of social relations based on gender, class, and social origins in order to analyze, simultaneously, reconfigurations of the practices of care providers (midwives, obstetricians, anesthetists) and those of couples, at a time when doubt is being cast on the place of techniques in the medical field and questions are being raised about the places men and women are taking in childbirth labor.

Keywords: Pains - Childbirth - Health - Public Policies - Medical Practices - Feminism