The Rhetoric of “Natural” in Natural Childbirth

7/26/2019 The Rhetoric of Natural in Natural Childbirth

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Copyright 2004 Elsevier Ltd. All rights reserved.

The rhetoric of natural in natural childirth! childearing "o#en$s perspectives onprolonged pregnancy and induction of laour

Rachel Emma Westfall , ,aand Cecilia Benoit , ,b

a%epart#ent of Anthropology& 'o( )0*0& +niversity of ,ictoria& ,ictoria& 'C& Canada,- )/*

%epart#ent of ociology& 'o( )0*0& +niversity of ,ictoria& ,ictoria& 'C& Canada,- )/*

Availale online 21 eruary 2004.

Abstract

3t is "idely no"n that the notion of prolonged pregnancy& defined #edically as 415 or425 "ees gestation& has een hotly deated "ithin the #edical and #id"iferyco##unities for #any decades. ithin this deate& pregnant "o#en$s voices haverarely een heard. /resented here are the results of a 6ualitative study of self7care in

pregnancy& irth and lactation "ith a non7rando# sa#ple of "o#en in 'ritishColu#ia& Canada. A panel of 28 "o#en "as intervie"ed in the third tri#ester of

pregnancy& and 2) of the sa#e participants "ere re7intervie"ed post7partu# 9*0intervie"s in total:. 3ntervie"s "ere tape7recorded& transcried& and analy;edthe#atically. ather theysa" it as an inconvenience& a "orry to their friends& fa#ilies and #aternity care

providers& and a prolongation of physical disco#fort. The findings are interpreted ye(a#ining the literature on the #edicali;ation?healthici;ation of childirth.

Author Keywords: /regnancy self7care@ /rolonged pregnancy@ atural childirth@

eferences
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Introduction

The length of hu#an gestation is calculated fro# the first day of the last #enstrualperiod& and is e(pected to e 2-0 days?40 "ees 9Cooe& 18:. =et there is variation&for so#e "o#en "ill conceive earlier or later in their cycles& cycle lengths vary& and the

aies of other "o#enDfor reasons still unno"nD"ill si#ply re6uire a shorter orlonger gestation period. inally& health prole#s affecting so#e "o#en or their aies#ay result in the early or late onset of laour.

%espite such variation due to health and iological processes& there are strongdifferences of opinion "ithin the scientific co##unity regarding the actual length ofhu#an gestation& and the degree to "hich intervention is necessary "hen pregnanciesgo eyond a particular ti#efra#e. 3ndeed& the length of gestation has een deated inthe #edical literature for over a hundred years 9Ahn /helan& 1-:. o#e e(perts#aintain that there is no set opti#u# gestational period 9 Feirse& 11:. Gthers allude toan erroneous interpretation of old #edical te(ts that calculate the length of gestation

fro# the end of the last #enstrual period& rather than the eginning& #eaning that "ehaitually underesti#ate the average length of gestation 9 'asett agele& 2000:. Thedate of conception itself can e inaccurately #ared. To co#plicate #atters& dating the

pregnancy through ultrasound technology creates the i#pression that #ale aies aresignificantly #ore liely to e carried eyond ter# than fe#ale aies& as seen in a"edish study including H*H&42) deliveries 9 %ivon& erer& isell& estgren& 2002:.This pheno#enon has een attriuted to a dating error in ultrasound feto#etry& due tothe fact that dating is ased on fetal si;e& and #ale aies tend to e slightly larger onaverage than fe#ale aies 9 Fitlinsi& Fallen&


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is highly suKective& and its clinical significance is 6uestionale 9 hearer Estes&1-*:. >ecent concern had also een raised aout #acroso#ia 9large si;e: in postdates

aies 9


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Carlsen& 1-8@ 'oyd et al.& 1--@ Fat; et al.& 1-)@ %evoe holl& 1-)@ Iauth&Jood#an& Jilstrap& 1-0:& and other studies have found no appreciale difference inoutco#e 9 >oach >ogers& 18@ ational 3nstitute of Child Iealth and Iu#an%evelop#ent et"or of


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value Kudge#ents in favour of their o"n lived e(perience. Gn the asis of the findingsof other researchers studying the #edicali;ation of childirth and its alternatives 9Cart"right& 18@ Corea& 1-*@


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changes "ere re6uested:.


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Co#pared to the average Canadian "o#an giving irth today& then& our researchparticipants "ould liely fall outside the nor# and to"ards the less conventional& #oreradical or fringe end of the spectru# "here #edical technology and artificialintervention into the irthing process are liely to e vie"ed "ith scepticis#& if nottotally reKected out of hand.

The participants chose the location of the intervie"s@ "henever possile& intervie"stoo place in the "o#en$s ho#es& as this "as often #ost convenient for soon7to7e andne" #others. 'y necessity& one intervie" "as done y phone& and one intervie" "asdone y e#ail. T"o intervie"s too place in a coffee shop. The first author conductedall of the intervie"s. Gut of necessity& and as a #eans to estalish rapport& she too heryoungest childDa ae7in7ar#sDto #any of the intervie"s. Gften the research

participantsN infants and s#all children "ere also present during the intervie"s. Theintervie" at#osphere "as #ostly casual and the intervie" style conversational. This

process facilitated the sharing of very personal infor#ation regarding the e(periences ofpregnancy and childirth& though the researcher often needed to stop the tape recorder

"hile a #other 9the intervie"er or intervie"ee: handled the s#all crises that punctuatethe daily lives of s#all children. uch reas tended to e short and did not prevent usfro# covering all of the intervie" 6uestions. The intervie"s "ere guided y a set ofintervie" schedules& "hich included ite#s relating to the follo"ing issues& addressed inno specific order.

B the "o#an$s socio7de#ographic characteristics 9first intervie" only:@B self7care practices& 4@B e(periences "ith #aternity care& in this pregnancy and past pregnancies& includingho" the care provider "as chosen& and his?her attitude to"ards self7care@B perspectives on issues such as heral #edicine& phar#aceutical drugs& and induction oflaour@B pri#ary sources of self7care infor#ation and support@B prolonged laour?laour induction@B irth e(perience& and sense of satisfaction "ith it 9second intervie" only:@B advice she "ould give to other pregnant "o#en 9second intervie" only:.

ith relevance to this specific paper& in her third tri#ester of pregnancy& each of the 28research participants "as ased to give her vie" on prolonged pregnancy and inductionand "hether or not she "as open to the use of proactive #easures& either under thereco##endation of physicians or #id"ives or y taing the #atter into her o"n hands.

Those "o#en "ho had een through an heral 9n2: or #edical 9n): induction efore"ere also ased aout this prior e(perience.

!hematic analysis

The#atic analysis& the analytical #ethod used here& is fre6uently e#ployed to process6ualitative data 9e& 1@ einer& "ain& olf& Jottlie& 2001@ /hipps& 2001@Fit;inger ill#ott& 2002:. Gne of the strengths of the#atic analysis is its aility to

ridge positivist 9hypothesis7testing: and interpretive 9hypothesis7generating:#ethodologies y translating 6ualitative data into for#s that can e interpreted andevaluated y ShardN scientists 9 'oyat;is& 1-@ %en;in Lincoln& 14@


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Though the #ain focus of this research "as on self7care& the intervie" transcriptsco#prised a rich te(tual data set that provided far #ore than a catalogue of self7carestrategies used. The study also allo"ed for a "indo" on "o#en$s e(periences of

pregnancy& irth& lactation and overall #aternity care. Through the lengthy process ofconducting and transcriing the intervie"s& an inti#ate no"ledge of the data e#erged&

and road patterns eca#e recognisale. These patterns for#ed the foundations of thepaper$s the#atic analysis 9'oyat;is& 1-:.

The#atic analysis egan "ith the identification of the#es that "ere inherent in theintervie" 6uestions& such as the "o#en$s use of alternative and conventional re#ediesand their thoughts and feelings ehind the decision to #edicate or not. Gnce suchthe#es "ere identified throughout the te(t& they "ere catalogued and co#pared forconsistency and patterns& for instance the relationships et"een "o#en$s perspectiveson self7#edicating and their age& parity& and style of #aternity care. Thereafter& deeperanalysis "as conducted into the#es "hich "ere not uilt into the intervie" 6uestions&

ut rather e#erged fro# the data. These included social issues such as ho" pregnancy

"as received in the "orplace& and "ith particular relevance to this paper& ho" friends&fa#ily #e#ers& and #aternity caregivers responded to pregnancy eyond 40 "eesgestation.

Results

Women"s #iews in the third trimester


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got an astrological #o#ent that it "ants to ic it off in the right direction in life. 3donNt see any prole# "ith carrying #y ay around in #y elly until it$s ready to co#eout. These "o#en shared the philosophy of Snatural childirthN and that Snature no"s

estN. They "ent on to note that they "ere not really certain as to the actual date ofconception& any"ay& and they felt that the policy of #andatory induction after 42 "ees

does not reflect the est interests of #others and aies.

o#en$s vie"s on laour induction 9"hether y taing proactive #easures or allo"ingphysicians to intervene into the irthing process: "ere loosely associated "ith style of#aternity care. one of the "o#en in physician care said they "ere philosophicallyopposed to #edical or do7it7yourself induction of laour. These "o#en also stronglyapproved taing proactive #easures to avoid prolonged pregnancy& including heral#edications. Gnly one of the si( "o#en in physician care said she "ould avoidinduction unless there "as a #edical reason for it 9other than prolonged pregnancy:. 3ncontrast& "o#en "ith registered #id"ives "ere #ore liely to e opposed to any for#of induction& and relatively less liely to use proactive #easures to sti#ulate their

laour. o#en "ith lay irth attendants& and those "ho "ere unassisted& "ere even lessliely to support #edical induction and the #ost un"illing to tae proactive #easures toend a prolonged pregnancy. These latter groups of "o#en said& al#ost universally& thatthey supported natural childirth and "anted Sto let nature tae its courseN.

These findings #ay si#ply indicate that "o#en "ho feel strongly against #edicalintervention of any sort are #ore liely to choose #id"ifery care& or to avoid the for#alhealth care syste# entirely. 3t #ay also indicate that #aternity care providers had giventhe "o#en infor#ation that influenced their vie"s on laour induction. or instance&certified #id"ives in this province are liely to advise their clients to use a variety of

proactive #easures to avoid prolonged pregnancy ecause their regulatory College doesnot support ho#eirth after 42 "ees gestation& at "hich point they are #andated torefer the "o#an to an ostetrician 9College of oie %avis7loyd 914:in "hich irthing "o#en fell roughly into t"o

road categories! professional "o#en "ho "ere co#fortale "ith highlytechnologi;ed& #edicali;ed irth and in favour of induction and Earth


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%avis7loyd& 14& p. 11)H:& "ith a s#all group of other "o#en falling so#e"here in7et"een. 3n the study reported on here& research participantsN educational andoccupational acgrounds had no earing on "hether they chose ho#e or hospital irth&or on "hether they said they "ould have laour induced if they "ent post7dates.

To su# up at this point& "hen ased their vie"s on prolonged pregnancy and laourinduction "hile in their third tri#ester of pregnancy& under half of the 28 "o#enintervie"ed agreed "ith laour induction y either taing the #atter into their o"nhands and using proactive #eans& or giving the#selves over to the #edical profession.The #aKority "ere either opposed to induction outright& or they "ould agree toinduction only if there "ere health prole#s for #other and?or ay@ these "o#en "ere#ore liely to have chosen non7physician styles of irth attendance. 3n their co##onvie"& it see#ed est to let nature tae its course and have a natural irth& to restrainfro# Scapturing "o#en$s "o#sN 9Galey& 1-4: and Sintervening to produce their

aies on so#eone else$s ti#eN 9


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9o(ygen deprivation:& "hich affects heart rate 9cialli van Tonningen& 2001:. This"o#an e(pressed her disappoint#ent "ith the irth outco#e 9a planned ho#e irthending in a Cesarean:& and she felt that her choice to have a #edical induction "asfro"ned upon y her friends. As she put it& 3 felt unco#fortale even saying that 3chose the Cervidil Wprostaglandin E2X induction& and then this happened. =es& it$s #y

fault& and it "as the Cervidil. This hinted at so#e stig#a surrounding #edicalintervention in childirth "hich #ay e only apparent in the Snatural childirthNco##unity& ut "arrants further investigation.

even of the other eight "o#en "hose pregnancies "ent eyond 40 "ees gestationused self7help #easures to sti#ulate laour. Gf those "ho said in the initial intervie"that they "ere philosophically opposed to induction& three "ent eyond 40 "eesgestation& and parado(ically& all three used proactive #easures to sti#ulate laour. 3t isalso notale that none of the "o#en re6uested a #edical induction at any ti#e@ they didnot consider prolonged pregnancy to e a #edical prole# in and of itself. >ather& they

preferred to tae #atters into their o"n hands. Gnly one "o#an "ho passed the 407

"ee #ar #ade no atte#pt to induce laour& in spite of pressure fro# her fa#ilyphysician@ she gave irth at ho#e at 42 "ees gestation& "ith a lay irth attendantpresent. >ather than atte#pting to start her o"n laour& she chose to avoid seeing thephysician for the re#ainder of her pregnancy!

The doctor started asing& "ell "hen "ould you induce& since you donNt "ant to do itat ten days or "hateverP And 3 "as lie& 3 donNt no" actually& 3 donNt thin 3 "ouldinduce& it$s not #y plan. +nless there "as a reason to& a strong reason esides the factthat 3N# overdue. And so it "as Kust ind of a""ard& and then "e left it at that. Then 3said& S3N# not going to go see any #ore doctors until after she$s ornN ecause 3 didnNt"ant to feel lie there #ight e so#ething "rong "ith her& and that 3Nd e anirresponsile #other not to& you no"& chec that out& "hen 3 felt that everything "asfine. o that$s "hat 3 did.

Apart fro# this one individual& "e "ondered& "hy "ere these "o#enDa purposefulsa#ple specifically chosen for the study ecause they e#raced self7careDnot "illingto let S


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the possiility of losing the opportunity to give irth at ho#e& one #id"ifery client saidthat she #oved the date of her last #enstrual period ac a "ee at her initial #id"iferyvisit& uying herself an e(tra "ee at the end. he said& e "erenNt a hundred percenttruthful aout "hen the first day of #y last #enstrual cycle "as& Kust so that "e couldhave so#e e(tra ti#e. e have no desire at all to e induced. T"o others said that& in

retrospect& they "ish they had done the sa#e and "ould do so in any future pregnancy.This practice of #oving the date of conception ac in ti#e is also found a#ongAoriginal "o#en in s#all northern co##unities of Canada "ho "ant to avoid have to

e evacuated to southern hospitals "here they are e(pected to deliver their aiesso#eti#es thousands of ilo#etres fro# their ho#es 9 Faufert GNeil& 1):.

Gther "o#en too proactive #easures due to pressure fro# fa#ily and?or friends. Asone "o#an said& /eople "ere calling every day& and 3 felt lie 3 "as doing so#ething"rong that 3 hadnNt produced this ay yet. 'ecause of this pressure& going eyond 40"ees gestation "as associated "ith an increasing sense of isolation. 3n the "ords ofanother "o#an& 3 felt lie 3 needed a circle of "o#en that 3 could Koin& and then stand

and chant "ith or so#ething. At the end& 3 "as alone.

or three other "o#en e(periencing health challenges or severe physical disco#fort"hile pregnant& prolonged pregnancy #eant continuing physical disco#fort andsicness. As one "o#an said& regarding her insulin7dependent gestational diaetes& itruins your pregnancy. =ou get really sic of eing pregnant. Another "o#an "hoinduced her laour "ith acupressure said& 3 "as so ready to e done. 3 had ad ede#a&and half an hour after W#y husandX let go of #y anles& there "ere still thu# printsthere.

or a fe" "o#en& other non7health related factors shaped their decision to intervene intheir pregnancy. o#e #ale partners had used up vacation ti#e "aiting for the

pregnancy to end& ti#e that theyNd planned to spend "ith the ne" ay and assistingtheir partner in her recovery. As a result of this prole#& one "o#an searched theinternet for self7help induction #ethods& and also perfor#ed vigorous e(ercise&including roc7cli#ing. As she put it& 3 tried to find so#e WinductionX drugs& ut 3could not find any. 3 searched the internet& Chinese "esites. o#e foods can help. 3t$svery si#ple@ you Kust #ae rice soup& and add a WparticularX vegetale. Another "o#an"hose partner$s vacation "as dra"ing to a close also tried nu#erous inductiontechni6ues& none of "hich proved to e successful. Gther research has also reportedho" fa#ily and friends tend to influence the decisions "o#en #ae aout childirth

alternatives 9Annandale& 1--:.

$iscussion and conclusion

e egan this study "ith the assu#ption that pregnant "o#en "ho identifiedthe#selves as espousing self7care "ould e inclined to let nature tae its course and notchoose to intervene in their post7date pregnancies. As noted aove& ho"ever& ourassu#ption "as proven to e false@ "e found that #ost of the "o#en "e intervie"ed"ere inclined to intervene "hen their pregnancy "ent eyond an esti#ated 40 "eesduration. %o7it7yourself interventions "ere #uch preferred over #edical interventions&liely ecause self7help #ethods of induction allo"ed this particular group of "o#en to

guide their o"n care rather than follo" their caregiver$s orders& and they "ere readilyavailale. 3n addition& do7it7yourself induction techni6ues could e used early& often 9if
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4BS0C6Y-2&_user=686342&_coverDate=10%2F31%2F2004&_rdoc=1&_fmt=full&_orig=search&_cdi=5925&_sort=d&_docanchor=&view=c&_acct=C000037258&_version=1&_urlVersion=0&_userid=686342&md5=60ac5596ba178a539b58b8fff0cd6419#bib47http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4BS0C6Y-2&_user=686342&_coverDate=10%2F31%2F2004&_rdoc=1&_fmt=full&_orig=search&_cdi=5925&_sort=d&_docanchor=&view=c&_acct=C000037258&_version=1&_urlVersion=0&_userid=686342&md5=60ac5596ba178a539b58b8fff0cd6419#bib4http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4BS0C6Y-2&_user=686342&_coverDate=10%2F31%2F2004&_rdoc=1&_fmt=full&_orig=search&_cdi=5925&_sort=d&_docanchor=&view=c&_acct=C000037258&_version=1&_urlVersion=0&_userid=686342&md5=60ac5596ba178a539b58b8fff0cd6419#bib47http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4BS0C6Y-2&_user=686342&_coverDate=10%2F31%2F2004&_rdoc=1&_fmt=full&_orig=search&_cdi=5925&_sort=d&_docanchor=&view=c&_acct=C000037258&_version=1&_urlVersion=0&_userid=686342&md5=60ac5596ba178a539b58b8fff0cd6419#bib4


13/20

necessary:& and in the privacy of the "o#en$s o"n ho#es. Even fa#ily #e#ers andfriends did not have to no".

Gne sociological interpretation of "o#en$s proactive ehaviour follo"ing prolongedpregnancy is that it indicates personal agencyon their part and their strength at resisting

technological do#inance over their reproductive health and find a "o#an7centredalternative to #ale7#edical control 9>oth#an& 1-H@ Galey& 1-4@ Corea& 1-*@Jraha# Galey& 1-H:. Conrad 912:points out that increased use of self7care

practices& a#ong other challenges fro# enlightened clients& can result in thede#edicali;ation of a life event such as childirth and its healthici;ationDi.e.&return to its rightful #oral do#ain under the control of "o#en the#selves. As one

participant pointed out aout ho" she "as self7#onitoring her pregnancy! it$s good toestalish a aseline lood pressure& 3 thin. 'ut 3Nve never had high lood pressure in#y life& so 3 Kust tend to go y "hat 3 feel lie. IavenNt een to a doctor in years. hileshe "as a"are of the health co#plications that occur in so#e pregnancies& she preferredto do the #onitoring herself& and "ould see #edical attention only if she discovered a

serious prole#.

A second interpretation is that "o#en$s vie"s of reproduction& lie other hu#anprocesses& reflect the larger culture in "hich they are e#edded. Though there is so#eindication that pregnancy and childirth are a#a;ingly #edicali;ed in high7inco#esocieties 9


14/20

conceptsconstituted throughdialogue "ith io#edicineV The fra#e"ors of "o#en&their partners and friends& #id"ives& nurses and ostetricians are unliely to e opposedin an ontological sense ut instead #ay elide and collide in response to local conte(ts9e#phasis in original:. hile the "o#en in our study "ere unusual in that they#ounted strong opposition to #edical interventions& they are nevertheless typical of the

#aKority of irthing "o#en in high7inco#e countries such as Canada in that they tooaction rather than letting their pregnancies run their course 9%evries& 'enoit& vanTeiKlingen& rede& 2001:. Lie the rest of us& #any of the "o#en "ho e(perienced

pregnancy eyond 40 "ees learned aout possile interventions through socialnet"ors& including their friends& fa#ily& and #aternity care providers. or e(a#ple&one "o#an said! 3 heard Waout lue cohosh and other hersX through other "o#en"ho have irthed naturally "ith #id"ives at ho#e. hile the receipt of suchinfor#ation is so#eti#es e#po"ering& as sho"n aove& these social contacts can alsohave a negative i#pact to the e(tent that they pressure "o#en into feeling SdeviantN ifthey allo" their pregnancies to continue eyond a socially acceptale local nor#.oerts and =oung 911:"ho found that "o#en"ere #ore liely to say they "ould prefer an induction afterthey actually passed theiresti#ated due dates. As a solution& >oerts and =oung suggest that the first step #ustsurely e to aandon the ter# Se(pected date of delivery 911& p. 110*:. Theirinvestigation did not go into "o#en$s reasons for desiring an induction@ the prole#"as assu#ed to e solvale through education. Io"ever& as "e discovered& "o#en$sco#prehension of the appro(i#ate nature of the Sdue dateN did not alter the lielihoodthat they "ould choose to intervene after 40 "ees gestation.

This research "as conducted "ith a co##unity of "o#en "ho had e(pressed aninterest in pre7 and post7natal self7care. >esearch in other geographic regions and "ith

other co##unities of "o#en "ould further our understanding of the central the#es thate#erged here. o#en$s vie"s on laour induction are heretofore under7investigated&and additionally& #ore research is needed regarding the i#pact of prolonged pregnancyon "o#en$s lives. Gur preli#inary findings& for e(a#ple& suggest those "o#en "hose

pregnancies go eyond 40 "ees gestation #ay have an elevated need for socialsupport. ocial support is no"n to have a positive i#pact on perinatal outco#es9eld#an& %unel& and#an& adh"a& 2000@ %aCosta& %ritsa& Larouche& 'render&2000@ %eKin Farlsson et al.& 2000:. A perceived lac of social support for post7dates"o#en along "ith the Shigh risN classification i#posed y their #aternity care

providers 9


15/20

"o#en "hose pregnancies go eyond 40 "ees gestation& as out tentative findingssuggest.

Any future research in this area should first7and7fore#ost place "o#en$s vie"s centrestage& and recogni;e that "o#en can under certain circu#stances e active #anagers of

their o"n health and not #erely dise#odied suKects of #edical intervention.Io"ever& "hether or not "o#en are ale or indeed "ant to resist the cultural tendencyto intervene on their o"n initiative in natural processes such as childirth re#ains to eseen.

References

Ahn& ecord incopusZ Cited 'y in copus 9)H:Augensen& F.& 'ergsKo& /.& Eiland& T.& Asvi& F. and Carlsen& M.& 1-8. >ando#i;ed

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The Rhetoric of “Natural” in Natural Childbirth

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