A social work exploration of distress in childbirth

Fleming, Christiana Kate MacDougall (2017) A social work exploration of distress in childbirth. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Emerging evidence suggests childbirth is often experienced as a distressing life event. Currently there is very little social work literature regarding childbirth, and the non-obstetrical focused childbirth literature from other disciplines often ignores or pathologizes the experiences of those who express distress in relation to childbirth. Social work’s silence in this area contributes to the continued uncritical acceptance of dominant childbirth discourses, and the oppression and marginalization of those whose experiences are outside dominant understandings of childbirth. This study was carried out in response to this void in the social work knowledge and practice base. It used a feminist narrative inquiry and analysis to explore the question, “What are individuals’ experiences of distress in childbirth?” Using a conceptual framework consistent with a commitment to human rights and social justice, this study paid specific attention to how experiences of distress are produced through an analysis of discourse, power/knowledge, agency, and the body. Fifteen women were interviewed for this study. Their individual interviews were examined for themes related to intrapersonal experience, interpersonal experience, culture, and structural/institutional domains. The results of this study show how oppressive, gender-based discourses can interact with mechanisms of power and associated ideas of agency, to create distress among women during childbirth. Interpreted themes pertaining to Discourse were: (1) Good Mothers, (2) Good Mothers and Good Patient, (3) Women as Over-dramatic, (4) Women as Diva, and (5) Women as Heterosexual. With respect to themes identified within Power/Knowledge, I uncovered: (1) Disciplinary Power, (2) Regimes of truth/Subjugated Knowledge, and (3) Resistance. The participants demonstrated the various ways in which their identities and social locations affected their birth experiences. The themes pertaining to Gender and Intersections of Identity were: (1) Women as Invisible or Secondary, (2) Invisibility of Whiteness and Other Privileged Identities, (3) Exceptions of the Invisibility of Privilege, and (4) Awareness of Marginalization. The participants who had problematic childbirth experiences took up the concepts of Distress and Emotion variously, and I interpreted the themes within this section as: (1) Hormones, (2) Distress as a Sign Something Has Gone Wrong, (3) Distress as Normal and Helpful, (4) Emotional Pain and Distress as Pathology and Mental Illness, and (5) The Language of Trauma. The participants’ narratives also disrupted the dominant view of birth stories. Themes in Childbirth and Narrative included: (1) Narratives Reflecting the Nonlinear Structure of Childbirth, (2) Inclusion of Previous Birth Stories in the Narratives, (3) Use of Narrative Devices in Childbirth Stories, and (4) Iterative Knowledge Production Additionally, the findings of this study shed light on the theme of Emotional Labour and Caring Work as it related to the work birthing women undertook during childbirth, and explored the often conflicting and polarized expectations of women and views of childbirth that birthing women navigated during childbirth. Interpreted themes related to Polarities were: (1) Medical (with interventions) and Natural (no interventions) Childbirth, (2) Expecting Women to Make Decisions versus Not Allowing Women Input into Decisions, (3) The Homework Paradox, and (4) Breastfeeding. The findings of this study also point to factors that might lessen the effects of distress in childbirth. Themes identified in How to Help were: (1) Recognize that Childbirth is a Regular Event that is Special; (2) The Importance of support from Others including a discussion of the themes of; (a) Community and Partners, (b) Relationship with Physicians, and (c) Angels Among us; and (3) Someone to Talk To. The findings of this study are positioned within the emerging field of human rights in childbirth as it fits within the guiding principles of the International Federation of Social Workers. As social work is concerned with improving human rights of all people, these findings have implications for a broad range of social work practice, theory, and research.

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