Rivista per le Medical Humanities

Isabella Pelizzari Villa
rMH 48, 2021, 25-31

Birth and violence from Leboyer to social networks

From a sociological point of view, medicine represents the new form of birth control. Not only does the medical institution act as a guarantor of health during childbirth, but it also performs a ritual function, marking the woman’s transition to the status of mother according to the canons of the society she lives in. In technology-assisted childbirth, external interventions prevail over the woman’s autonomy and innate competence with respect to her body. Therefore, violence at birth appears to be associated, on the one hand, with unnecessary procedures and, on the other, with a socio-cultural form of medicalisation. Childbirth is defined and assisted as a medical event; it is managed based on a separation between body and mind, between physical and mental needs that implies that the former are given priori- ty. Delegation is encouraged; the woman is subjected to protocols; her resources and her active role are inhibited. What is perceived as violent are often the – unexpected – acts suffered, being explained as “aids” without the mediation of the relationship, rather than the procedures themselves. Even non-intervention can be experienced as abuse if it does not occur respecting the woman’s individual needs. From this point of view, obstetric violence can be defined as the extreme consequence of the distance existing between the operators’ good intentions, the ways of management and the perception of women in labour.

Michel Odent
rMH 48, 2021, 32-36

From childbirth socialisation to

From a diachronic point of view, violence is as old as the socialisation of childbirth and dates back as early as the Neolithic, when men first began to interfere with the spontaneous process of labour with a series of actions, rituals, and beliefs. These practices spread because they offered man an evolutionary advantage, favouring the development of aggressiveness. In fact, every time the spontaneous childbirth process is disturbed, the production of the “love hormones” involved in bond and attachment is inhibited. Today, however, the domination over nature has reached its peak and the way children come into the world gives rise to significant questions about the future of our species. For instance, it has been found that a high number of caesarean sections can result in long-term consequences on the health of newborns, which are not colonised by the beneficial bacteria present in the maternal vaginal canal. In this framework we can easily understand the need for a paradigm shift. In clinical practice this means the transition from care based on “control” to accompaniment based on the woman’s “protection” from all neocortical stimuli – light, language, coming and going of people – which disturb the spontaneous childbirth process. Recent scientific discoveries gave hope for such a change, provided that we adopt an approach based on a salutogenic model and formulate the appropriate questions.

Laura Lazzari
rMH 48, 2021, 37-43

Childbirth stories in Italian-speaking part of Switzerland

The article analyses two autobiographical texts published in the Canton of Ticino over the last few years: I wanted to travel to the Netherlands to give birth: Story of an announced caesarean section (2018), by Isabella Pelizzari Villa, and What unites us. From midwife Lucia to our and your childbirth (2019), by Angela Notari. The books, of a hybrid genre, tell about two very different experiences, the first of which is traumatic, and the second positive. The article provides an investigation of the reasons un- derlying the writing and highlights some key elements that contribute to discriminating a positive childbirth experience from a negative one. An insight into the purposes of the stories is equally offered, highlighting how both texts, with an openly feminist intent, are aimed at contributing to changing – through the narration of intimate experiences and the sharing of practical information based on scientific evidence – a culture of childbirth based on the risk and often ineffective communication between doctors and patients, inspiring mothers to ask themselves and other people questions, to gather information and reflect on the options available to them, in order to make informed and aware choices that help them go through a positive childbirth experience.

Solène Gouilhers
rMH 48, 2021, 44-46

"Obstetric violence": a feminist turn?

Feminism has played a key role in giving visibility to the birth experience. From a gender perspective, the biomedical model of childbirth care is influenced by social constructions that have been developed based on the biological difference between the sexes. In this perspective, labour has often been interpreted as a deviance from the norm; control over the body of the woman in labour has been seen as a way to restore her passivity and “innate” docility, while communication has contributed to strengthening hierarchical relationships. From a feminist point of view, the debate on violence represents an opportunity to rethink childbirth management, reflecting on the gender bias, the approach to risk and the forms of collaboration between doctors, midwives and women.

Monya Todesco Bernasconi
rMH 48, 2021, 47-51

Is it possible to avoid traumatic interventions during childbirth?

Several scientific studies confirm the effectiveness of continuous care by a qualified midwife for low-risk childbirths. In this respect, particularly significant is the experience of the cantonal hospital of Aarau, which in 2016 created an autonomous space for non-medicalised deliveries within its area (Haus 16). This model, which is illustrated in the article, was especially designed to enhance the competence of midwives as well as meeting the needs of women with low-risk pregnancy, giving them the opportunity to give birth with the midwife while relying on the safety offered by the proximity of a hospital facility. The home is managed by midwives according to the “same room” system, which welcomes women from the onset of labour up to the post-natal period. In the event of complications, the woman in labour is transferred to the hospital medical ward, which can ensure timely treatment. When medical intervention is unavoidable, the operators offer appropriate support and help women so that they can go through the experience of medicalised childbirth in a serene way. The quality of obstetrics can be improved thanks to scientific evidence, collaboration and work on one’s fears.

Niccolò Giovannini
rMH 48, 2021, 52-56

Towards an integrated perspective of health in obstetrics

The article highlights the need for a paradigm shift towards the integration between “survival medicine” and new knowledge acquired through the contribution of different disciplines, including neurosciences and social sciences, which make it possible to achieve a critical evaluation of the benefits and limitations of childbirth medicalisation. Now, if on the one hand the advent of the biomedical model made it possible to save lives in difficult cases, on the other hand the progressive spread of artificial birth, which was then further extended to include low-risk parts as well, caused a weakening of the human microbiota, thus favouring the onset of the so-called “new plagues”. Studies conducted on women’s health actually highlight what was lost with the advent of the biomedical model, also due to the fact that women have so often lost contact with their own physiological and inner rhythms, giving up autonomy in exchange for physical safety. This is why the implementation of the Mynd & Co project got under way at the Mangiagalli clinic in Milan, based on a holistic path that promotes empowerment and a healthy and conscious pregnancy by increasing women’s self-confidence and providing them with the necessary tools to keep control even in the event of a medicalised childbirth.

Delta Geiler Caroli
rMH 48, 2021, 57-60

Power relations in Swiss obstetrics

For several years now, scientific evidence has shown that continuous midwife support throughout the maternity period (including delivery in low-risk cases) is associated with equal safety, lower costs, higher satisfaction rates for women, and less surgery or drug treatments. In spite of this, midwives are marginalised and underused in Switzerland. According to four British researchers, in order to understand the reasons we need to analyse the distribution of power and knowledge among midwives, women and medical professions. The different power structures that affect the Swiss obstetrics system are examined in the article, drawing on Michel Foucault’s concepts: gaze, surveillance, power of discipline/knowledge and docile body. From this we can infer that maternity care has a negativeimpact on both the women’s personal autonomy and midwives’ professional autonomy. A better understanding of the power structures that regulate relationships in the Swiss obstetric system would facilitate the implementation of continuous support provided by a trusted midwife, resorting to medical interventions as needed. This model has already been applied in various cantons with the system of out-of-hospital deliveries or extra midwives. In addition to a significant reduction in costs, this would result in a decrease in surgery and in the morbidity associated with the latter.

Mattia Lepori
Anna Fossati
Delta Geiler Caroli
Niccolò Giovannini
Isabella Pelizzari Villa
Christian Polli
Clara Scropetta
Monya Todesco Bernasconi
rMH 48, 2021, 61-69

How to prevent

The article proposes in written form the debate that followed the oral speeches on the occasion of the conference “Birth and violence: a thinkable relationship?”, held in Lugano on 12th November 2019 and organised in collaboration with the Nascere Bene Association. The debate, which also saw the involvement of the public, began with a series of questions addressed to the speakers by Mattia Lepori. The round table saw the participa- tion, among others, of the head of the Department of Gynaecol- ogy and Obstetrics of the Civic Hospital in Lugano, Christian Polli, and of the independent midwife Anna Fossati, who were invited to present their own experience in the framework of birth care.

Graziano Martignoni
Ambra Pesenti
Elisa Tommasin
Ramona Farina
Donatella Torraco
Deborah Pacifico
Valentina Basile
Davide Mantilla
rMH 48, 2021, 97-114

Following the path: a walk through sensitive thinking

The reflections of the Ticino-based psychiatrist and professor on the theme of “sensitive reason” introduce and define the context of a series of papers written by the students who, in 2020-2021 academic year, attended his lectures entitled: Di alcune parole filosofiche nei saperi e nelle pratiche psicoterapeutiche. Postille di filosofia della Cura [On some philosophical words in knowledge and in psychotherapeutic practices. Notes on Caregiving Philosophy], as part of the cursus studiorum in psychoanalytic psychotherapy of the Istituto Ricerche di Gruppo in Lugano. These focus on various topics, namely: Waiting and the meeting (Ambra Pesenti), Void (Elisa Tommasin), The figures of beauty (Ramona Farina), Ulysses and the mad flight and Abraham... (Donatella Torraco), “Only for the one who sits and sings...” (Deborah Pacifico), “In the forest there is an unexpected clearing...” (Valentina Basile), “And the soul, my dear, is healed with certain spells...” (Davide Mantilla).