The technocratic, humanistic, and holistic paradigms of childbirth

Davis-Floyd Robbie
2002 Journal of Japan Academy of Midwifery  
This article describes three paradigms of health care that heavily influence contemporary childbirth, most particularly in the West, but increasingly around the world: the technocratic, humanistic, and holistic models of medicine. These models differ fundamentally in their definitions of the body and its relationship to the mind, and thus in the health care approaches they charter. The technocratic model stresses mind-body separation and sees the body as a machine; the humanistic model
more » ... stic model emphasizes mind-body connection and defines the body as an organism; the holistic model insists on the oneness of body, mind, and spirit and defines the body as an energy field in constant interaction with other energy fields. Based on many years of research into contemporary childbirth, most especially through interviews with physicians, midwives, nurses, and mothers, this article seeks to describe the twelve tenets of each paradigm as they apply to contemporary obstetrical and health care, and to point out their futuristic implications. I suggest that practitioners who combine elements of all three paradigms have a unique opportunity to create the most effective obstetrical system ever known. This article describes three paradigms of health care that heavily influence contemporary childbirth, most particularly in Western, industrialized nations, but now increasingly all over the globe. 1 I call these three paradigms the technocratic, humanistic, and holistic models of medicine (Davis-Floyd 1992; Davis-Floyd and St. John 1998). Of these three paradigms, humanism as a model for change stands the best chance of success in this era of the deepening penetration of technology into birth; thus "Humanizing Childbirth" was a most appropriate theme for the International Congress on Humanizing Childbirth held in Fortaleza Brazil in 2000, which the articles in this volume reflect. But in order to understand humanism in health care and obstetrics, it is essential to understand the other two approaches as well. THE TECHNOCRATIC MODEL OF MEDICINE The way a society conceives of and uses technology reflects and perpetuates the value and belief system that underlies it. Despite its pretenses to scientific rigor, the Western medical system is less grounded in science than in its wider cultural context; like all health care systems, it embodies the biases and beliefs of the society that created it. Western society's core value system is strongly oriented toward science, high technology, economic profit, and patriarchally governed institutions (Davis-Floyd 1992). Our medical system reflects that core value system: its successes are founded in science, effected by technology, and carried out through large institutions governed by patriarchal ideologies in a profit-driven economic context. Among these core values, in both medicine and the wider society, technology reigns supreme. As has been clear for over twenty years, most routine obstetrical procedures have little or no scientific evidence to justify them. They are routinely performed not because they make scientific sense but because they make cultural sense. As we shall see below, they exemplify certain fundamental aspects of technocratic life. The Twelve Tenets of the Technocratic Model (1) Mind-body Separation and (2) The Body as Machine. The main value underlying the technocratic paradigm of medicine is separation. The principle of separation states that things are better understood outside of their context, that is, divorced from related objects or persons. Technomedicine continually separates the individual into component parts, the process of reproduction into constituent elements, and experience of childbirth from the flow of life. But first and foremost, it separates the human body from the human mind. The body presents a profound conceptual paradox to our society, for it is simultaneously a creation of nature and the focal point of culture. How can we be separate from nature when we are part
doi:10.3418/jjam.16.67 fatcat:rqmd2m3jtbd53jqmv753ga2iym