The Medicalization of Birth and Death

Improving how individuals give birth and die in the United States requires reforming the regulatory, reimbursement, and legal structures that centralize care in hospitals and prevent the growth of community-based alternatives. In 1900, most Americans gave birth and died at home, with minimal medical intervention. By contrast, most Americans today begin and end their lives in hospitals. The medicalization we now see is due in large part to federal and state policies that draw patients away from community-based providers, such as birth centers and hospice care, and toward the most intensive and costliest kinds of care. But the evidence suggests that birthing and dying people receive too much—even harmful—medical intervention. In The Medicalization of Birth and Death, political scientist Lauren K. Hall describes how and why birth and death became medicalized events. While hospitalization provides certain benefits, she acknowledges, it also creates harms, limiting patient autonomy, driving up costs, and causing a cascade of interventions, many with serious side effects. Tracing the regulatory, legal, and financial policies that centralize care during birth and death, Hall argues that medicalization reduces competition, stifles innovation, and prevents individuals from accessing the most appropriate care during their most vulnerable moments. She also examines the profound implications of policy-enforced medicalization on informed consent and shows how medicalization challenges the healthcare community's most foundational ethical commitments. Drawing on interviews with medical and nonmedical healthcare providers, as well as surveys of patients and their families, Hall provides a broad overview of the costs, benefits, and origins of medicalized birth and death. The Medicalization of Birth and Death is required reading for academics, patients, providers, policymakers, and anyone else interested in how policy shapes healthcare options and limits patients and providers during life's most profound moments.