Surveillance, support and risk in the postnatal period.

ABSTRACT

There have been significant changes in the way that maternity services have been organised in recent years. One of the most dramatic has been the significant reduction of time women spend in hospital following childbirth. Yet despite this there has been little debate about whether additional home and community-based support services might be needed for mothers and their newborn infants. At the same time, though, there has been a seemingly parallel occurrence--growing emphasis on the importance of 'early intervention' (including the antenatal as well as the postnatal period) to maximise the health and wellbeing of infants and their mothers. This involves the identification of 'at risk' families and children, and service provision or surveillance that is home or community-based. Two recently implemented strategies in South Australia target maternal and child health in the postnatal period. One is a local program which provides home-based support (the 'Mothercarer' program). The other is a South Australian government sponsored Universal Home Visiting Program called Every Chance for Every Child. While there are variations in the emphases of the programs, it is suggested that an important trend in policy regarding the postnatal period involves an elision between two kinds of objectives: maternal support in the home, and 'early intervention' to minimise the risk of health and social problems. Furthermore, it could be argued that risk assessment through surveillance is being seen as at least as important, if not even more important, than the provision of support. Finally, the trend to early discharge, going hand in hand with the emphasis on surveillance of these programs, suggests a loosening of the medicalised appropriation of the postnatal period in favour of a wider social panopticon.

KEY WORDS

Sociology, postnatal support, social policy, perinatal surveillance

Policy framework: the postnatal period

There is little doubt that childbirth in the twentieth century had become emblematic of the phenomenon of medicalisation, with ever increasing rates of medical intervention defining the event as a situation of inherent risk requiring technological management (Lane 1995, Tew 1990). The postnatal period was not exempt from this medicalisation. Not only did childbirth increasingly take place in the medical setting of the hospital, it was followed by a period of 'lying in', sometimes for a period of weeks, during which time the condition of mother and baby were monitored by midwives and medical staff (McCalman 1998). Mothers were physically taken care of, and of course were encouraged to feed and regulate their newborn's behaviour according to the dominant dictates of the time (Leavitt 1986). In the latter decades of the twentieth century, broader political and economic policies such as economic rationalism exerted a sustained challenge, albeit indirectly, on some aspects of medicalisation. For example, these policies militated against the economic drain of such lengthy hospitalisation, especially for what many were declaring to be a 'normal physiological process'. It is noteworthy, then, that despite the progressive medicalisation of birth, competing pressures are evident in the way that the postnatal period has become constructed, managed and understood. In this paper several of the current initiatives involving postnatal interventions, particularly in South Australia (SA), are described and analysed.

Early discharge