Appropriate technology in obstetrics: definition and assessment of the public and of health professionals

Abstract

The starting point is the hypothesis that in order to satisfy the population's health needs it is necessary, among other things, that the health services should make use of appropriate technologies. The problem is to define that which is considered "appropriate" and who should define it. To that end a research project was carried out such as to permit the comparative detection and analysis of the definition that is given, from the point of view of the population and the professionals concerned, of the appropriate technology in obstetrics as well as of the technology utilized in the different sectors of health care (public, social services and private). Data on two aspects of care are provided: utilization of biomedical techniques and procedures (push, pant, episiotomy, anesthesia) and consideration of the interpersonal relationships in the care process (continuity of care, the father's role, the strengthening of the mother-child tie, etc.). It is observed that there are differentiated methods of care according to the care sector: they are more "technologized" and medicalized in the private sector. At the same time the interpersonal relationships which favor health care receive greater attention within this sector. Furthermore, the professionals' opinions about what they consider appropriate agree largely with those of the mothers in this sector, showing thus that their needs are satisfied to a larger extent than those of mothers in the other sectors. Therefore the requirements of the majority of the patients who receive care from public and social services are satisfied to a smaller extent - which runs counter to the risk approach which directs the resources of those sectors to those groups regarded as vulnerable.