Explaining obstetric interventionism: Technical skills, common conceptualisations, or collective countertransference?

The usual explanations for the widespread increased use of Caesarean surgery are that it is a technically straightforward and safe procedure associated with improved perinatal outcomes and that women are choosing to give birth by surgery. It is proposed in this article that obstetric clinicians share internalized beliefs which shape their interactions with childbearing women and can depersonalize maternity care and contribute to the use of operative interventions in childbirth. The origins, validity and impact on clinical practice of these assumptions are analyzed. It is suggested that the belief that birth is only normal retrospectively creates an anxiety-laden approach to care in which the prospect of catastrophes leads to avoidance and intervention: and that considering the foetus as a separate patient results in increased surveillance of women's behaviours. Physician authority reflects traditional power relations in health care and information from technology precludes other ways of knowing. (c) 2008 Elsevier Ltd. All rights reserved.