Stillbirth: medicalisation and social change, 1901-1992, with special reference to Scotland

In Scotland, medical understanding of, medical practice in relation to, and medical attitudes towards stillbirth, its prevention and management underwent significant changes throughout the twentieth century. This thesis argues that these changes were shaped by technological and scientific advances in medicine, greater specialisation, and changes in public health practices. It also argues, however, that medical developments were closely linked to broader social, legal and religious concerns around the meanings given to stillbirth. This thesis focuses particularly on the ways in which these developments were evident in Glasgow, and locates change more broadly within Scotland, and indeed, Britain as a whole. This thesis underlines the reasons behind the medical attention towards stillbirths and the prevention of stillbirths from the early twentieth century onwards. It also shows how the legislations in regards to stillbirths as well as the societal perspective on stillbirth influenced and were influenced by the changing medical attention. Medical articles and reports on stillbirths in Glasgow, Scotland and the rest of Britain were analysed to investigate the progress and increase knowledge in understanding the causes of stillbirths and how to prevent those stillbirths. It is highlighted how the medical community focused first on purely obstetric causes of stillbirths to then extend their gaze towards broader causes such as social class and nutrition. The thesis also emphasises how the attention towards stillbirth by the medical profession encouraged always greater medicalisation and hospitalisation of childbearing and childbirth, and this trend was accelerated after the establishment of the National Health Service. The welfare system was a promise of a healthy population, in regards to pregnancy and childbirth, of live births. This meant a medical responsibility was felt to offer the best care, skills and technologies available in order to deliver healthy live babies, hence averting any preventable stillbirths. A lower fertility rate, the promise of live birth through highly skilled medical care and the increased use of obstetric ultrasound changed the societal view of fetuses towards them being regarded as babies even during pregnancy, and thus changed societal perceptions of stillbirth. From the late 1970s, the evolution in society’s views towards stillbirth influenced the medical perspective by demanding a change in the management of stillbirth alongside the provision of support to mothers and, where applicable, their families. Medical professionals, for example, stopped telling women to just start planning for a new pregnancy, but emphasis on the loss that was a stillbirth and the need to grieve became central. This is one of the numerous transformations around the management and support to mothers/families that will be highlighted. This thesis also argues that the evolution in the understanding and prevention of stillbirths by the medical profession as well as the changes of the societal view on stillbirth resulted in developments towards the religious perspective on stillbirth in the late twentieth century, with regards to theology and pastoral care. The changes in medical perspectives towards stillbirths are highlighted, and also how they influenced legalisations, and societal and religious views. The evolution throughout the twentieth century, and especially in the late twentieth century, of those different perspectives are the reasons behind our current understanding of stillbirths and the way we respond to stillbirth. This thesis contributes to increase our understanding of the medical developments around stillbirth as well as the inter-relationship between these different aspects influencing stillbirths in twentieth century Scotland and Britain. An example of this would be that the medical advances helped prevent stillbirth as well as increase the fetal viability earlier in pregnancy, explaining the change of the legal definition of stillbirth in 1992 in Scotland, England and Wales