Childbirth embodiment: Problematic aspects of current understandings

School of Nursing, Midwifery and Physiotherapy, University of Nottingham.
Sociology of Health & Illness (Impact Factor: 1.88). 12/2009; 32(3):486-501. DOI: 10.1111/j.1467-9566.2009.01207.x
Source: PubMed


The experience of childbirth is one of the most corporeal of the human condition. Against a backdrop of profound change in the milieu of birthing over the past 30 years, especially in the developed world, a number of discourses now compete for the status of the safest, most fulfilling birth experience. Supporters of biomedical and 'natural' approaches make their respective claims to those, with obstetricians broadly aligning their professional interests with the former and midwives with the latter. There is mounting evidence that childbearing women's experiences of birth are often shaped in the uneasy space between the two. Within sociological discourse in health, embodiment is a dominant theme but, to date, research has concentrated mainly on new reproductive technologies, and there is a dearth of recent research and theorising around the act of parturition itself. This paper argues that because of this, there has been a polarising tendency in current discourses which is having a largely negative impact on women, professionals and the maternity services. A call is made for an integration of traditional childbirth embodiment theories, mediated through compassionate, relationally focused maternity care, especially when labour complications develop.

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    • "We take as our focus maternity care, a setting in which competing discourses about the most appropriate way to care for and support labouring women are well established (Walsh, 2010) and different options are (at least in theory) open to women (Miller and Shriver, 2012). While we acknowledge there are some important differences between maternity care and the diabetes care context within which Mol's work developed, we believe it is appropriate to use her work here. "
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    ABSTRACT: Choice and patient involvement in decision-making are strong aspirations of contemporary healthcare. One of the most striking areas in which this is played out is maternity care where recent policy has focused on choice and supporting normal birth. However, birth is sometimes not straightforward and unanticipated complications can rapidly reduce choice. We draw on the accounts of women who experienced delay during labour with their first child. This occurs when progress is slow, and syntocinon is administered to strengthen and regulate contractions. Once delay has been recognized, the clinical circumstances limit choice. Drawing on Mol's work on the logics of choice and care, we explore how, although often upsetting, women accepted that their choices and plans were no longer feasible. The majority were happy to defer to professionals who they regarded as having the necessary technical expertise, while some adopted a more traditional medical model and actively rejected involvement in decision-making altogether. Only a minority wanted to continue active involvement in decision-making, although the extent to which the possibility existed for them to do so was questionable. Women appeared to accept that their ideals of choice and involvement had to be abandoned, and that clinical circumstances legitimately changed events.
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    • "The medicalisation of childbirth has been savagely critiqued, often from a Foucauldian perspective (Arney 1982; Hunt and Symons 1995), showing women as constructed objects within hierarchical discourses. However, Walsh (2010) has argued persuasively that women in practice find themselves caught in an uneasy space between biomedical and natural discourses, with even more limited power than had their condition been merely medicalised. Critics of the medicalisation of obesity have called the moralistic discourses that convey a sense of crisis and declare 'war on obesity' (Throsby 2012, 9) 'alarming, if not alarmist' (Rich et al. 2010, 271). "
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    • "It is a construct that has been deployed in making sense of patient satisfaction (Heffernan et al. 2010), a focus for therapy (Gilbert 2010), safeguarding patients from abuse (Care Quality Commission 2011), emotional self-management (Neff et al. 2008) solidarity with marginalised and oppressed people (Rigoni 2007) and enhancing education for future healthcare professionals (Shield et al. 2011). In sociology, accounts of social justice have also emphasised compassion (Williams 2008), as have exhortations towards improving healthcare (Walsh 2010). It is claimed that through the actions of compassion practitioners can become more fully geared towards understanding patients than implementing procedures (Sieger et al. 2012). "
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