Logics of health care and embodied trust in medical encounters

Abstract

The article analyzes different logics of organization of medical care in Russian obstetrics. The attention is focused on trust relationship between healthcare professionals and a mother to be, and particularly, on the bodily dimension of such trust. Many researchers note the crisis of institutional trust in Russian medicine. Within the frame of neo-liberal logic, i.e. the logic of choice, citizen-consumers (usually, from highly educated and wealthy background) address this crisis by the purchasing personalized attention of the medical professional. Within the logic of care, which is associated with the "natural" approach to childbirth, trust becomes embodied. Careful preparation for the birth of a child gains special importance. To ensure that a woman will be able to "give birth by herself" (without undue intervention), the midwife and the expectant mother accomplish serious extensive work preparing her body for labour. The other component of the 83 trust relationship is the practical trust between a client and her individual midwife. As a result of a prolonged (during several months) interaction, the midwife and her client get to know how each of them behaves in different situations. Thus, in addition to the ideological aspect, the "natural child-birth" model incorporates practical differences from the purely medical model, which is prevalent in Russia. Delivery in these two cases is produced in different ways. The paper relies on the works of the Netherland philosopher Annemarie Mol. Empirical basis is constituted by interviews with medical personnel and mothers from four Russian maternity hospitals.