Information control and the exercise of power in the obstetrical encounter

TLDR: The information sought by pregnant women from their obstetricians is used to provide a case study of one conceptualization and test of the utility of the concept of power.

About: This article is published in Social Science & Medicine.The article was published on 1983-01-01 and is currently open access. It has received 74 citations till now.

Figures

Table 5. Respondents who, early in pregnancy, state they would like to discuss topics with their obstetricians and the extent to which, by late pregnancy, discussion has taken place

Table 6. Respondents who, early in pregnancy, state they would like to discuss topics with their obstetricians and the extent to which, by late pregnancy,

Table 1. Type of care by social class

Table 7. Patients who, late in pregnancy, state they would still like information from their obstetricians by patient’s type of care, controlling for social class

Table 2. Which of the following areas would you like to discuss with your doctor early in pregnancy?

Table 8. Attitude to asking the doctor questions by type of care, controlling for social class

Frequently asked questions

Q1. What are the contributions in "Information control and the exercise of power in the obstetrical encounter" ?

While a number of studies have focused upon the doctor/patient relationship, few have examined the utility of the concept of power and its capacity to help us understand the outcome of these interactions. The information sought by pregnant women from their obstetricians is used to provide a case study of one conceptualization and test of the utility of the concept of power. Doctor/patient interaction involves two participants, and an adequate understanding of the interaction process must encompass the patient ’ s apparent unwillingness to ask questions [ 3,4 ] as well as the clinicians ’ reluctance to provide it. This study examines the encounters between pregnant women and their obstetricians. The emerging conflict between the advocates of the new natural childbirth movement and their medical critics provides a background for this study. The routine use of regular antenatal care provided by an obstetrician ( not a general practitioner or nurse ) is illustrative of the new orientation to obstetrical care. The routine and unproblematic nature of most antenatal care coupled with the differing perceptions by obstetricians and at least some of their patients provides the ingredients for possible conflict and therefore an ideal environment in which to examine the exercise of power. While there have been numerous discussions of the concept of power and its measurement [ 15 ], Lukes [ 16 ] has provided the most interesting extension of the concept. The two dimensional view suggests that the study of overt conflict may not reveal all situations in which power has been exercised. According to this third view, one could examine obstetrical encounters to determine whether women may be acting against their own Social Science and Medicine ( 1983 ) 17 ( 3 ): 139-146. doi:10. While interests might be interpreted in a number of ways, the authors suggest the following definition for the purposes of this study. In this study the service which clients might desire is information about the health of their baby, about labour, appropriate health behaviour and some other topics ( e. g. books to read, sexual relations during pregnancy ). The study began with a period of observation and semi-structured interviews in a large public hospital which accounts for about half the births in a city of approx. Private obstetricians participating in the study were selected by their university colleagues partly because they were active in academic activities. Thus these obstetricians are not representative of obstetricians but are likely to be more interested in the types of concerns addressed in this study. The study was presented as a survey of respondents needs, particularly for information about their pregnancy. Which of the following areas would you like to discuss with your doctor early in pregnancy ? Secondly, the issue is not whether the information is ‘ really ’ wanted but rather that if women report a desire to be better informed then one may appropriately determine whether Social Science and Medicine ( 1983 ) 17 ( 3 ): 139-146. doi:10. 1016/0277-9536 ( 83 ) 90247-2 as amniocentesis, ultrasound and electronic fetal monitoring have further contributed to the increased perceived importance of regular antenatal care in the care of pregnant women. The second questionnaire repeated the list of items from the PIL, but this time with a request that clients should indicate whether the topic was discussed with their obstetrician ( no/yes ) and secondly whether further discussion on each topic was desired ( no/yes ). The fact that women were presented with a list of items for discussion may suggest the possibility of some form of acquiescent bias. There are three responses to this suggestion. 

Q2. What are the main factors that have contributed to the increased perceived importance of regular antenatal care?

Procedures suchas amniocentesis, ultrasound and electronic fetal monitoring have further contributed to the increased perceived importance of regular antenatal care in the care of pregnant women. 

Q3. How does one know if power is being exercised?

One may know if power has been exercised by observing that a person or group has acted against their own interests, even though they may express satisfaction and contentment with the outcome. 

Q4. What was the period of observation and semi-structured interviews?

The study began with a period of observation and semi-structured interviews in a large public hospital which accounts for about half the births in a city of approx. 

Q5. What has changed in the social environment associated with childbirth?

Traditional relationships and sources of information exchange have been curtailed as reproduction, labour and childbirth have become part of a new medical science.