At a time when the midwifery profession, and the wider structure of maternity care, is a matter for popular and political debate, this book is a timely contribution. It will be an invaluable read for all those interested in maternity care in England. Wordery is one of the UK's largest online booksellers. With millions of satisfied customers who enjoy low prices on a huge range of books, we offer a reliable and trusted service and consistently receive excellent feedback. We offer a huge range of over 8 million books; bestsellers, children's books, cheap paperbacks, baby books, special edition hardbacks, and textbooks.
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A social history of maternity and childbirth : key themes in maternity care in SearchWorks catalog
Wordery offers Free Delivery on all UK orders, and competitively priced international delivery. We find rare books for you These take a little longer to source. Please check the expected dispatch details above. Huge range Over 7 million titles and growing, all at extremely competitive prices. International delivery varies by country, please see the Wordery store help page for details. About Wordery Wordery is one of the UK's largest online booksellers. Gabe et al. Phenomenology highlights the totality of lived experience, emanating from the connections between physical, psychological and social dimensions.
In addition, critical perspectives to embodiment have been foregrounded by Foucault , Bourdieu and feminist writers like de Beauvoir and Martin These argue that vested interests and social conditions seek to secure jurisdiction over the body and regulate its behaviour. Within this complex mix, a tension between personal agency and social structure is played out. Thus the body becomes the source of social relations and human behaviours. Arguably, the justification for the medicalisation of childbirth, in part, lay with the belief that female physiology was flawed Martin The Enlightenment period reinforced this by promoting the separation between mind and body Cartesian dualism — Davis and Walker with the body becoming the object of dissection and examination.
Thus, the natural body strand of embodiment resulted in an essentialist view that the female body was defective, and encouraged the introduction of various drugs and obstetric procedures to regulate and control labour and birth. However, since the s, there has been a feminist backlash against patriarchal views of the female body and the medicalisation of birth Oakley with some feminists endorsing an essentialism at the other end of the spectrum, reifying natural birth Kaplan and Rogers , Daly Essentialist positioning implies both an objectivist epistemology and ontology that is exclusionary and marginalising to other perspectives Dyson and Brown There is little room for equivocation or uncertainty Downe and McCourt Proponents have a tendency to take up contrasting views that birth should either be medicalised or natural, childbirth physiology is inherently faulty or trustworthy, hospital birth is safer than home birth and so on.
This creates ambivalence and uncertainty when birth does not conform to prior expectations, sometimes resulting in profound disappointment and distress for women Thomson The view that bodies are circumscribed and bounded by external social effects arose in the 20 th century.
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Foucault had a seminal influence over this period and he, more than any other theorist, is credited with the promotion of a socially constructed understanding of embodiment Nettleton For Foucault, various discourses produced subjectivities in bodies that regulated behaviour and experience. Though social constructionism has been an important counterbalance to biological essentialism, it has struggled to address the carnal characteristics and expressions of the body.
There is no doubt though that social constructionism has added a missing dimension to embodiment that begins to posit the body as being acted on by external forces that impinge on behaviour and experience. If the body fades to the background under the power of discourse, it has a habit of reasserting its presence through the senses Shilling Some body sensations, like pain, completely dominate consciousness and any embodiment theory that does not address sensorium will be found wanting. He viewed perception and consciousness as intrinsically linked to the body.
One cannot exist without the other. Central to this idea was intentionality — the way of the body being and acting in the world which was the sum of bodily experience, physicality and emotions. The perspective also begins to rehabilitate agency alongside structure. Such an approach challenges the reductionism of medicalisation because bodies are so much more than the sum of their individual parts.
This approach has found strong resonance with the nursing and midwifery professions. The visceral physicality of the labour experience is unusual in foregrounding both external and internal bodily processes. Pain is an almost universal manifestation of this but, uniquely, does not generally represent pathology.
For these reasons its lived experience forms a personal narrative for women that remains vivid over many years Simkin Embodiment understood in this way may underplay the influence of social structures but eschews any essentialism by emphasising the constructing of knowledge meaning by individuals as they interact with their environment.
It also opens up the possibility of experientially derived knowledge sources alongside scientific knowledge. These differing perspectives on embodiment can both enrich and obfuscate understandings of childbirth embodiment. Before exploring ways that a reconstructed concept of embodiment could resolve these dualisms, the crises that currently afflict maternity services will be further elaborated on.
In July , Channel 5 in the UK showed a documentary on freebirthing. It told the stories of three women who chose labour and birth without the attendance of any childbirth professionals. The notoriety of the programme resulted in the Royal College of Obstetricians and Gynaecologists issuing a statement condemning the practice.
Freebirthing is a clandestine activity and there are no figures available as to its prevalence. A much larger group of women, though still small in percentage of overall births with the notable exception of the Netherlands , choose a home birth attended by a midwife. Though government policy in many Western countries is less hostile to home birth than in the past, overall numbers of women choosing home birth have only marginally increased. The reversal in the ratio of home to hospital birth since the s has been widely debated in the United Kingdom Tew , Mori et al.
They also privilege the mind over the body safety over lived experience. Intervention rates in labour and birth in the Western world are inexorably rising. Some years ago a review of caesarean section rates was carried out in the UK Thomas and Paranjothy and its conclusions revealed a reductionist focus on pathology only. Only tacit acknowledgement was given in the report to psychosocial determinants of the problem. The reductionism of the scientific method, exemplified in randomised controlled trials, promotes an essentialism in the application of knowledge and can blind stakeholders to the complexities of maternity care.
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The body of work just mentioned illustrates the contingent and contextual nature of childbirth. What is of grave concern for maternity services, apart from the physical morbidity and increased costs of intervention, is the considerable psychosocial sequelae attached to complicated labours and births.
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This augmented an earlier meta analysis by DiMatteo et al. There is a growing body of work by midwifery researchers regarding the psychological stress of prolonged labour Kjaergaard et al. Often their experiences are exacerbated by feelings of disappointment and guilt. Their dichotomised thinking regarding natural and medical birth contributed to their ambivalence and distress. This kind of thinking as already stated is found in professional approaches to birth as well Monari et al. That makes the findings of Kjaergaard et al. This occurs because the instrumental needs of the institution take precedence over the interpersonal needs of the client Walsh a.
In relation to assisting women to adjust their expectations when clinical events do not go to plan, childbirth professionals need to construct intervention not as medical rescue Grol and Grimshaw but as collaborative team work. Decision making throughout should be consultative and inclusive.
Then agency and a sense of control over events are more likely to be retained by the mother. In one of her pictures, her newborn baby has been placed on the edge of a golf course fairway. She remarks underneath the painting that the surgeon and anaesthetist were discussing golf during the procedure so she painted the picture as a mark of protest to them disrespecting the event. There is a dearth of maternity care literature detailing positive examples of teamwork or multidisciplinary collaboration in partnership with women.
The teamwork was characterised by mutual respect for differing but complementary roles and shared commitment to normalising birth. In relation to reframing caesarean birth as not necessarily a disappointing outcome, the following anecdote is instructive. The woman had constructed this storyline about the unpredictable nature of birth.
She saw preparing for her birth as analogous to climbing a mountain she had never climbed before. Her plan was, along with a companion, to take the A route which was direct and challenging but nevertheless the most straightforward home birth. Success clearly was dependent on fine weather and her feeling well on the day. Either way she got to the top and the achievement was hers to savour. Callister reminds us of the power of the birth story in integrating positive and negative events into our life narrative and it may be that this way of framing, on the face of it, a disappointing outcome would facilitate this process.
Every woman could be introduced to this type of narrative in advance of labour so that she can remain flexible if the need arises and all childbirth professionals could work within this framing as occasions arise. This still requires sensitive and respectful communication and decision making in labour, and attention to the environmental ambience in operating theatres but, if these areas could be addressed, birth trauma narratives may diminish. So far no mention has been made of an ethical position, fleshing out the meaning of humane maternity care.
Feminist virtue ethics emphasises the primacy of relationships in directing ethical behaviour.
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These relationships are characterised by equality, mutuality and respect. What flows from these encounters are caring, kindness and compassion, eschewing power and manipulation.
A similar idea has been forwarded by Downe and McCourt in relation to maternity care — salutogenesis or wellbeing. Humane care from this perspective then means empathic and kind care, predicated on relationships of equality, openness and trust. This needs to be sustained throughout the labour and birth experience and especially when complications arise. This section attempts to map an understanding of embodiment that engages with the best of the various strands without lapsing into essentialism.
With reference to childbirth, at first glance, the naturalistic view has a heady appeal. After all, despite its fallibility, it has been extremely successful at reproducing humankind over millions of years. It is reasonable therefore to start from a position which maintains that physiology is purposeful and sufficient in the main. Some women will develop complications that require appropriate medical and technical intervention, but these should be the exception. This reference point leaves open for the moment the question of the appropriateness of elective intervention in the absence of complications.
The pessimism attached to prior, androcentric readings of the female reproductive system has already been alluded to and in the present the focus of most of the research in childbirth remains on pathology. A cursory glance at the Cochrane Library for Pregnancy and Childbirth where the vast majority of systematic reviews target medical interventions confirms this fact.
Odent has suggested that the marriage of hormones is sensitive to environmental conditions and draws heavily on animal studies to support a proposition that the birth environment should not be disturbed.