Obstetric demise or resilience? The moral panic surrounding obstetric malpractice litigation in South Africa and the vilification of midwife-led births.

PROBLEM AND

BACKGROUND

When South African obstetricians, majority care providers for pregnant and birthing persons in the private-sector experienced exponential increases in medical indemnity insurance premiums, predictions were made that medico-legal risk would bring about their demise by 2020. I coin the terms 'obstetric demise' and 'obstetric resilience' to highlight how the outcry confirms an obstetric malpractice litigation moral panic. In contrast, the corresponding dissolution of independent midwifery - at the exact date predicted for an obstetric demise - went relatively unnoticed.

RESEARCH QUESTION: How did private-sector 'obstetric resilience' ensue despite its predicted demise, and how did midwives become 'folk devils' in an obstetric malpractice litigation moral panic?

METHODS

Data comes from in-depth, longitudinal interviews with seven obstetricians, a narrative interview with leading medical litigation lawyer, and participant observation across multiple sites over two-and-a-half years of fieldwork between 2017 and 2019.

FINDINGS AND DISCUSSION: I highlight the relational processes symbolised in tussles over hegemony in risk societies, wherein even elite professionals are objects of moral scrutiny and surveillance. The construction of a narrative of 'obstetric demise', part of a discursive strategy by moral entrepreneurs, amplified private-sector obstetric concerns, enabling individual and collective defensive practices that are negatively correlated with a denial of human rights in childbirth. A moral panic discourse upheld and stabilised unequal birthing relations. Emerging from the mutual entanglement of structures and agents in the healthcare system, the patient, who should be at the centre of care, ended up worst-off.

CONCLUSION

The medico-legal litigation 'crisis' construction process led by the Department of Health was strengthened by a private-sector, obstetric malpractice moral panic. In a vicious cycle inherent to medico-legal litigation, the cost and quality of healthcare provision has been significantly affected, ironically undermining the very propositions for universal healthcare that promoted a moral panic in the first place.