the pregnancy project
Emerging themes and questions

Notes on emerging themes and questions
- February 2003
 

The following are notes on fieldwork in progress.  They do not represented completed research, but are included here in order to illustrate how an ethnographic project might develop and how this particular project is developing now.
 
Please do not quote or cite without permission.

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Learning how to learn: Notes on conducting research

 

Importance of participant-observation naturalistic interviews based on observations at prenatal care appointments, conversations and informal interviews at community events and childbirth preparation classes

Following the lead of midwives in particular, reassessment of research issues regarding access instead, must view as opportunities and privileges regarding the subject of birth and what researchers call human subjects themselves with honor

Also, research issue of responsibility match openness with openness about the process

Work together to discover reciprocity as researcher, at least be able to offer clear reasons for why asking for generosity

Importance of caring, especially because process of childbearing and childbirth can be fraught with concerns learning on a personal, emotional level

Hopefully, enriching the experience for everyone

 

Managing threats to control and planning:

Ideas and practices of risk, fear, and faith

 

Women's embodied experiences of pregnancy their practices in terms of eating and exercise to assert control over their bodies, their feelings of loss of control as the pregnancy progresses, even their fears of losing control over basic bodily functions during and after labor (e.g., childbirth educators discussing possibilities of bowel movements during birth, urinary stress incontinence after birth)

 

Click here to read an excerpt from an interview transcript: Embodied "threats" to control and planning.

 

What do women fear?  What they cannot plan or control particular focus on the birth itself: 

 

  • Loss of self-control
  • Pain, not able to handle
  • Interventions, both necessary (because something happens) and unnecessary (especially if delivering in hospital) popularity of writing birth plans also, disappointment when not all goes as planned (e.g., C-sections)
  • Death, especially of child e.g., reactions of couples watching video of birth in childbirth education class, seemed especially long time before the baby began to breathe questions about what can happen with umbilical cord and any way to detect, such as wrapped around neck or knot in it

The problem that women's experiences during childbearing can and more often than not do depart from assumed narratives of clear, linear progress

 

Click here to read excerpts from interview transcripts: Departures from narratives of progress.

 

Need to attend to womens expressions of faith and hope, such as practices of prayer

Also, medicine and science as system of belief critiques of the science of prenatal care see Home versus hospital (next section)

 

Managing threats to control and planning:

Home versus hospital

 

The decision to birth at home (natural) associated with the desire to avoid unnecessary interventions advice even to women delivering at hospital to labor at home for as long as possible

Observed at midwives appointments, conversations about breastfeeding and attachment starting at birth, vaccination of children, use of herbs to treat physical complaints through their everyday activities, engaged in a critique of what they identify as mainstream American social and cultural ideas and practices concerning childbearing and child rearing

Discussion of medicalization

  • Need to understand what this means in everyday life among both health care providers and patients/clients in particular, patients/clients familiar with the term and a number have read books based on sociological studies of birth in the U.S.
  • Appears to encompass not only ideas and practices of medicine and science, but also the role of the state/government (e.g., time period for returning birth certificates, vaccination) and commercial/corporate interests (e.g., critical of health insurance coverage, liability issues that might motivate certain kinds of medical practices) also of American society and culture, such as gender roles (e.g., concerning parents themselves as well as awareness of history of midwifery and obstetrics in the United States)

Hospitals attempting to address medicalization critique doctors noting changes in practices during the last few decades also noting that patients themselves medicalize their own conditions keep in mind self-selection involved already in choosing care with doctor or midwife

For patients/clients, experienced not only an issue of control and authority, but also a reaction to hospitals as a workplace

  • Major complaint regarding time spent with patients and lack of rapport also, doctors aware of time constraints, point of pride that they make efforts to spend time
  • Comparison of intake or first appointments and management of information
  • Also, comparison of the spaces of the midwives versus doctors offices themselves noting talk about nesting at home (also moving and painting) among clients of midwives
  • Ideas about home as safe and/or hospital as safe

Health care providers own managing of work/family issues not the focus of this project, but topic worth further examination e.g., the number of certified nurse midwives in the hospital-based practice explained in part that they need to have a life also doctor reducing schedule and salary to spend more time with her own children

Need to maintain perspective in terms of history of midwifery in the United States that influence contemporary trends involving home births and hospital births

  • CDC reports most home births in the United States are rural and low-income women different conditions and motivations observed in Ann Arbor
  • Also, at hospital, certified nurse midwives and obstetricians economics also a factor in that midwives generally cost less, but relatively high demand for them in Ann Arbor issues need follow-up

Midwifery model of care as woman-to-woman also, holistic more questions asked and answered about everyday physical discomforts particular emphasis placed upon nutrition

 

Concern not necessarily with perfect child, but perception of the autonomy of the child and how to meet its needs

 

Click here to read an excerpt from an interview transcript: The autonomy of the child.

 

Pregnancy challenging distinctions between categories such as body and person, and physical, social, and cognitive noted in talk among expectant parents about needs of child such as food/nutrition, bonding, and stimulation the conflation of physical, social, and cognitive development

The importance of the physical and material in the imagination of kinship, especially the imagined child

Body not separable from person significance of seeing, feeling, and hearing the baby for both women and men

 

Click here to read an excerpt from an interview transcript: Body not separable from person.

 

Pregnancy practices as part of the "cultural work of constructing a person" (Layne 1997)

 

Pregnancy practices as themselves ways of asserting control over the outcome producing perfect pregnancies and perfect children which implies the impact of process on product and raises questions regarding kinship and personhood (mother and child) as imagined and enacted ideas and practices of sentimentalizing the unborn as children as one childbirth educator told her class, by taking care of yourself, you are taking care of your child

Routine use of ultrasound and other such technologies to survey and manage pregnancy as a demonstration of control as a result, a controversial and contested practice

 

Gender dimensions

 

The intensity of nuclear family imagery childbirth education classes

How to manage unwanted involvement from family members need for social support, such as doulas

Men as labor support, also recognition in childbirth education classes that expectations of men might be unrealistic

 

Nature/culture, modernity, and anthropology

 

Based on notes on entry into the field especially how I have introduced myself and the interest that anthropologists have had in issues of reproduction

Positive response to and familiarity with anthropology and anthropologists perception of self as counter-cultural? engagement in demodernizing talk characterization of their own actions or activities as a form of critique

Sense of American culture = modernity as wrong, bad, inferior, out of touch with nature, or just unnatural especially in matters relating to children and family as well as women the paradox that so-called primitives had it (or have it) more right closer to nature

Explicit references to anthropology in the materials that expectant parents use in their pursuit of education during pregnancy

  • Particular interest in how other cultures have treated women during pregnancy and birth Sheila Kitzinger, childbirth educator midwives lending library includes Robbie Davis-Floyd
  • However, other cultures often meaning hunter-gatherer groups modern European societies (they do things better in Sweden) alluded to far less often than I thought journalists, educators, and activists more likely to use these concrete examples than expectant parents themselves somewhat discouraging as it seems like the denial of actual possibilities for changed conditions

Human evolution to talk about the physiology of pregnancy, labor, and birth in fact, recently heard a paper at the anthropology meetings on the historical synergy between biological anthropology and obstetrics

 

  • Educators, childbirth guides using anthropology to explain developmental benefits encompassing physiological and social such as breastfeeding or co-sleeping in fact, during one childbirth educator deferred to me regarding which pumps might be recommended
  • To naturalize and reassure women of their bodies innate ability to bear and birth a child even without pain medications your body was made to do this also invoking kinship between the woman and her mother and all the women before them who had given birth
  • Observed discussion at childbirth class regarding Lucy, based on exercise from Birthing from Within collapsing of distinctions between the imagined behaviors of hominids and hunter-gatherers level of self-awareness of the inaccuracies of caveman talk nevertheless, trope familiar to all and served as imaginative and fruitful exercise in class

In sum, anthropology not just a side issue of entry into the field, but highlights important themes and questions concerning nature/culture and modernity domains over which anthropologists seen to have authority and knowledge also central issues in discussions of childbearing and childbirth

 


Your comments and questions on these notes will be appreciated.  Please click here to send an e-mail to sshan@umich.edu.
 
Many thanks.