Makt, motstånd och förändring : Vårdens historia speglad genom det svenska barnmorskeväsendet 1663-1908 : [the history of Swedish health care reflected through the official midwife-system 1663-1908]

Sammanfattning: The aim of this thesis has been to examine and analyze how the discourse of medical science was established, that is to say institutionalized in Swedish society during the eighteenth and the beginning of the nineteeenth century, and how a new form of maternity care developed within this framework. How these changes were constructed, legitimized, challenged, justified, and maintained are the principal themes developed in this thesis. The thesis is based on a theory, launched by the Swedish economic historian Anita Göransson, which deals with how meaning (knowledge) and power relations are materialized and changed. In this theory masculinity, discourse, and societal power bases play a central role. The thesis has therefore focused on masculinity and its need to tie itself to power, control and authority. The power base that is studied is the certified doctors' Collegium medicum, which was established in 1663 and converted into a formal National Board of Health in 1813. The discourse in question, brought forth by the 'collegium', has been termed the discourse of medical science. In the thesis it is shown how the discourse of medical science was transfered to maternity care and how the licensed midwives came to be included, as a subordinate group, within the official medical system. They thereby became carriers of the discourse of medical science and masculinity. It is also shown how the state's need for a large and healthy population, and the 'collegium's' need to strenghten the position of medical science among the populatiom created a situation in which it was necessary to allow licensed midwives to take a major role within maternity care and the public health sector. They were for instance given the internationally unique right to use obstetrical instruments, including sharp tools, in 1829. It is also shown how the direction of change was influenced by the resistance that was framed from below and how those excluded from political decision-making, such as women and those who lacked property, participated in the making and shaping of the new health and medical care system. Due to the resistance it was not until 1908 that the municipalities became obliged to employ licensed mid-wives.