Lessons in control: Prenatal education in the hospital

As childbirth has become medicalized, a gap has opened between the needs and wishes of the individual woman giving birth and the dictates of the institution where birth occurs, the hospital. One way the medical establishment has sought to reconcile these differences is through prenatal education. Drawing on participant observation of a series of prenatal classes for poor and working-class women at a large urban hospital and interviews with the participants in the program, I argue, however, that the class neglected many of the needs that pregnant women and their partners expressed. Moreover, the class engaged a variety of strategies to socialize women to comply with hospital routines and expectations, even at the expense of their own interests. This process, through which organizational needs are defined as therapeutic needs, was first described by Erving Goffman in Asylums (1961). Using Goffman's "medical service model," I contend that hospital-based prenatal education is primarily organized and designed to meet not individual, but institutional needs. Rather than empowering women to achieve their own goals in birth, the classes teach women to be compliant with the institutionally determined regimen for labor and delivery. Thus, prenatal education illustrates the growing gap between individual needs and institutional needs in the realm of health care in the U.S., as well as the growing burden placed on individuals to be responsible for their own health regardless of the powerful social configurations that constrain individual choices and experiences.