Gobernabilidad en los procesos de planeación participativa comunal y corregimental

Implicit in the scientiflc medical discourse is the assumption that age is a flxed and internally driven biological process. In the maternal age sub-discourse maternal age is given the signiflcance of being an independent variable, an essential uncontrollable factor that has effects on the woman's body. It is not seen as a consequence of living or of one's environment. Bromley ( 1 988, p. 29) suggests that there is confusion between ageing as a cause and ageing as an effect so that aging has become "self-explanatory" and "metaphysical". Correspondingly, the assumption that "older" women's bodies are different from younger women's is based on their "performance" during labour and birth.

Apparent in the maternal age discourse is the notion that women have two "lives": one is their overall body life and the second is their reproductive life (or as Higdon ( 1 960) terms it "obstetric age"). The latter is based solely on the period for which women are fertile. Hence, Evans et al ( 1 997) are able to confidently defme pregnant women aged over forty years "geriatric gravidas". Such women are "old" in terms of their reproductive capacity: they are not far from reproductive "death". Implicit in this view of dual aging processes, or of a life within a life, is the separation

9 I have decided to identify these as sub-discourses of the scientific medical discourse as they use the same criterion of scientific knowledge to constitute the 11 truth". However, each sub­ discourse constructs a specific object, that is, the maternal age sub-discourse constructs an aging female body and the defective body discourse constructs a reproductively defective body.

of women's reproductive lives from the context of their life experiences. The focus is solely on women's bodies and their reproductive role.

The age at which a woman became an "elderly primipara" remained undecided and contested in the American literature until 1 958. Various suggestions were asserted based on the average age span of women's ability to reproduce. For example, in 1 929 Schulze found that women had been labeled "elderly primiparas" from the age of 25 to 35 years. Freeland ( 1 9 1 5) searched for a common denominator on which the criterion of increasing age could be based. He suggested that the time between menarche and menopause could be divided into two fifteen-year blocks, with the age of 30 as the dividing year. Waters and Wager ( 1 950) argued that 35 was both a halfway point in life overall, and a common last third of reproductive life. In 1 958, at a meeting of the International Federation of Obstetricians and Gynaecologists (FIGO), a decision was made to identify first time pregnant women aged 35 and over as "elderly primigravidas" .

The call for a common defmition was related to an argued need for scientific rationalisation. For example, Waters and Wager ( 1 950) stated that "it is highly desirable from a standpoint of critical analysis to have a commonly designated and accepted age­ group for late primiparity . . . " (p.302). Warren ( 1 992) proposes that the development of obstetric risk criteria in relation to maternal age was based on mortality surveys carried out in 1 956. Such surveys would have provided information for analysis and permitted the realization of groups at risk. FIGO which was established in 1 954 aimed to advance scientific research and its direction across the international obstetric profession (Tew, 1 995). The defining of 35 as the age when a primipara becomes "elderly" by FIGO would have allowed studies from different countries to be compared with one another and to add to a growing body of scientific knowledge. Tew ( 1 995, p.65) states that an outcome of FIGO was the strengthening of obstetricians' power and influence.

Bromley ( 1 988) identifies two common images of ageing. The first image is of the body that contains a fixed amount of energy, which over time declines. The second portrays ageing as a battle between health and disease with the latter eventually becoming triumphant. Both of these images have been and continue to be evident within the medical literature regarding "elderly" primiparas.

The early writers constructed the "older" woman's body as one of reduced force and in particular, flexibility. In 1 9 1 2, Spain (citing Webster, year not cited in original text) attributed the "feeble uterine contractions" (p. 423) observed in "elderly"

primiparas to their age. With age the uterus becomes "slack and sagging" (Spain, 1 91 2). The perineum and cervix is depicted as rigid and inelastic (Points, 1 957; Randall, 1 949). De Lee (cited in Quigley, 1 93 1 ,) described the response of the perineum to birth as to " . . . tear in all directions like old rubber when stretched" (p. 234). Waters and Wager (1 950) call the "genital tract" of the "elderly" primipara "obsolescent" and Freeland ( 1 9 1 5) calls the uterus "senile". For these authors, the "elderly" primipara's reproductive system has reached its expiry date. It is decaying, if not already decayed.

In more recent literature, reference to the perineum and cervix has become silent with the focus placed on the uterus itself. The gaze has become even more specific, moving from macroscopic to microscopic, from organ to tissue, for now the gaze is on the muscle layer, the myometrium of the uterus and its arterial supply (Adashek, Peaceman, Lopez-Zeno, Minogue & Socol, 1 993; Cnattingius, Forman, Berendes & Isotala, 1 992; Cohen, Newman & Friedman, 1 980; Naeye, 1 983; Rosenthal & Brown, 1 998). These authors attribute the increased need of "elderly" primiparas for intervention during labour to the ageing uterus.

Ageing is seen to affect the flexibility of the whole of the woman's body. For example, Baird and Hutton ( 1 958) suggested that tissue degeneration similar to "disuse atrophy" occurred with age causing the problems "elderly" primiparas experienced in labour and breastfeeding. McFadyn (1 989) portrays the "elderly" primipara's body as becoming stiffened and increased in rigidity which affects her ligaments and muscles. Consequently, pregnancy is a greater burden for the "older" woman and McFadyn recommends that she needs more rest than would a younger woman. In contrast, Baird and Hutton ( 1 958) speculated that ageing may be brought about by a lack of cellular nutrition which, with research, could be rectified.

The second image of ageing, that of disease overtaking the body is also evident within the literature regarding the "elderly" primipara. In this image the "elderly" primipara's body is pathologised. The medical conditions are either evidently existent at the time of becoming pregnant or are latent and manifest themselves during the course of pregnancy (Harrigan, Hartko & Szas, 1 98 1). The two diseases most commonly identified in the literature associated with maternal age are hypertension and diabetes (Arthur & Kaltreider, 1 956; Beazley, 1 995; Cunningham et aI, 1 997; Hansen, 1 986; Utian & Kiwi, 1 988). It is argued that these diseases increase with age and complicate the course of pregnancy and the development and wellbeing of the baby.

What is evident in the above discussion is that the notions of diminishing force, lack of resilience and increasing pathology are actual assumptions upon which the "elderly" primipara sub-discourse is founded. The consequence of these assumptions is the belief that the body of the "elderly" primigravida is incapable of bearing and birthing her baby effectively. Furthermore the wellbeing of her baby is more likely to be threatened. The same consequences are envisaged for the "elderly" primigravida who has involuntarily delayed the birth of her first child. The cause of her problems however, derive from a different physical source.