Communicating Women's Health

Social and Cultural Norms that Influence Health Decisions

Annette Madlock Gatison

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781317553885
• Edition: 1
• Topic: Medicine
• Subtopic: Communication Studies

This volume explores the conditions under which women are empowered, and feel entitled, to make the health decisions that are best for them. At its core, it illuminates how the most basic element of communication, voice, has been summarily suppressed for entire groups of women when it comes to control of their own sexuality, reproductive lives, and health. By giving voice to these women's experiences, the book shines a light on ways to improve health communication for women.

Bringing together personal narratives, key theory and literature, and original qualitative and quantitative studies, the book provides an in-depth comparative picture of how and why women's health varies for distinct groups of women. Organized into four parts—historical influences on patient and provider perceptions, breast cancer the silence and the shame, make it taboo: mothering, reproduction, and womanhood, and sex, sexuality, relational health, and womanhood—each section is introduced with a brief synthesis and discussion of the key questions addressed across the chapters.

Section III Make it Taboo

5 Giving Voice to Women's Childbirth Preferences

Edith LeFebvre and Carmen Stitt

DOI: 10.4324/9781315732077-5

One of the most life-changing events a woman can experience is becoming pregnant and giving birth. Giving birth is a natural phenomenon, often stressful during the 39–42 weeks of gestation because of the many changes, both emotionally and physically, that a pregnant woman must grapple with while moving toward the process of delivery. This chapter identifies and examines current birthing practices offered by many hospitals primarily but not exclusively, found in the United States.

Background and History

Over the past one hundred years, the practice of women giving birth in the United States has shifted from becoming a natural occurrence in the home, predominantly attended by laypersons or midwives, to being treated as an increasingly medical phenomenon. By the mid-20th century, options for delivery had developed to offer hospital care resulting in more live births and with maternal mortality rates decreasing (Zwelling, 2008). The sterile accommodations and twilight sleep were welcomed as modern and desirable. At the same time, women’s dependence on the medical community to supervise their pregnancy and labor was established as the norm.

Gradually, the inclusion of advanced miracle pharmaceuticals to ease the pain of childbirth and induce labor, and the use of technology, were perceived by most as the only reasonable option to ensure a healthy delivery. What initially may have appeared as contemporary and safe birthing practices resulted in altering the process of giving birth, turning it into a complicated, risky, and unnatural experience. In fact, as medical technology has advanced, so has the increase in intervention-intensive labor and birth, along with women’s fear of labor or belief in their ability to cope with the pain of childbirth (Romano & Lothian, 2007). Zwelling (2008) found that some obstetricians actually frightened their nulliparous patients and that one woman obstetrician reportedly explained to her pregnant patient that “labor is barbaric” (p. 89).

Medically managed labor and delivery require most women to remain in bed in a supine position, which prohibits natural movement during labor as they are connected to an intravenous line and fetal monitor. Giving birth in a supine position does not facilitate giving birth naturally and most often prolongs labor (Gupta, Hofmeyr, & Smyth, 2004). Restricting movement while providing drugs that contradict a body’s natural labor process is often counterproductive and may contribute to unplanned Cesarean surgery.

The reasons for a shift from a naturalistic human experience to more of a medical model are many. Although birthing is a “natural” function of the body, it is not without risks to the mother and child. Some contemporary preferences for childbirth favor a predictable and neat outcome to “fit” with modern lifestyles (Mazzoni et al., 2010). In many cases, this includes surgical procedures for birth even though they are not medically necessary, such as routine episiotomies and Cesareans. Technology that can save a woman and her newborn’s lives has also greatly improved, providing life-saving capabilities, which have not otherwise been available. However, the previous century saw a rise in medically assisted births not witnessed before, and not necessarily medically indicated. It is for this reason we examine how and why historical practices have changed, and how these changes impact communication between women and medical professionals about birthing options.

Beginning in the late 1800s, as anesthesia and antiseptics were increasingly accepted, so too was Cesarean surgery (CS), whereby fetuses are delivered with the assistance of a surgeon slicing through the mother’s abdomen. CS has become more commonly used since the 1970s (Natcher, 2011). In 1970, 5% of all births were done by CS. As CS rates began to rise, the World Health Organization (WHO) stated, “There is no justification for any region to have CS rates higher than 10–15%” (World Health Organization, 2008b). By 2009, the CS rate skyrocketed to 32.9% (VBAC, 2013), and now CS rates have stabilized at 32% (Center for Disease Control and Prevention, 2014; Declercq, 2010; Hendrickson, 2012). Although a boon to medically necessary cases where the mother’s or the fetus’s life is at risk, the procedure of CS carries its own risk that may not be completely explained or revealed prior to elective CS deliveries.

Risks of CS to the mother include infection, blood loss, blood clots in the legs, pelvic organs, and lungs, injury to the bowel and bladder, and possible reactions to the anesthesia used (http://www.acog.org/Patients/FAQs/Cesarean-Birth#complications). Longer term risks to the mother include breaking open of the incision during subsequent labor and delivery, placenta previa, placenta accreta, placenta increta, and placenta percreta. These risks to the mother increase with each subsequent CS delivery. Risks to the infant include injury during delivery, need for care after delivery in a neonatal intensive care unit, and breathing problems (American Congress of Obstetricians and Gynecologists, 2011). Paradoxically, the increase in CS rates is not associated with a corresponding decrease in morbidity and mortality for mother and child (McCourt et al., 2007). The risk for postpartum maternal death is 3.6 times higher for women who have CS compared to those who deliver vaginally (Denuex-Tharaux, Carmona, Bouvier-Colle, & Breart, 2006).

Minority women are in a unique position when it comes to CS. Some minority women in the US are more likely to have CS compared to Caucasians. Among minorities in the United States, African Americans, Puerto Ricans, and American Indian/Alaskan Natives are more likely than whites to have CS (Getahun et al., 2009; Declercq, 2010; Braveman, Egerter, Edmonston, & Verdon, 1995). Some have speculated that differences in CS rates may be attributed to insurance types; however, several studies have shown that after adjusting for other risk factors, private and publicly insured women were equally likely to undergo CS (Haque, Faysel, & Khan, 2010; Movsas, Wells, Mongoven, & Grigorescu, 2012). Nonetheless, a comparative study of uninsured Nevada women found them less likely to undergo CS than women with insurance (Shen & Wei, 2012). The increase in CS presents a vexing social problem. On the one hand, minority women, like their Caucasian counterparts, are able to elect a delivery method to fit their preferences as much as their white counterparts. On the other hand, having higher CS rates, even as elective surgery, presents its own risks to women and newborns, as discussed earlier. Given that patient education is critical to making informed decisions during a pregnancy and the delivery, coupled with potential or indirect influences by medical personnel who support CS, women need to be educated about the risks from CS.

Of the women who choose to have CS, often many psychological, sociological, and cultural reasons explain how they came to elect CS. Several studies have shown that women obtain information about the birthing process from a variety of sources, including friends and family members, medical professionals, and the media (Miller & Shriver, 2012). Frequently, women don’t use this information in order to make an informed choice, but rather, to confirm previously held beliefs. Women selectively consult outsides sources that confirm their beliefs and then refute those sources that don’t. Consequently, informed consent no longer exists because the process of objectively weighing costs and benefits of procedures does not occur. These findings have been corroborated in several studies of patients who were not in favor of CS, but were anxious about the process of birth. After consulting their medical professionals, women were persuaded by their physicians to select CS to alleviate their anxiety over pain during delivery (Goldberg & Shorten, 2014; Hopkins, 2000; Malacrida & Boulton, 2014).

Most recent data show that the United States ranks 29th in the world on infant mortality, tied with Poland and Slovakia (National Center for Health Statistics, 2007). More disturbingly, CS rates were 2.4 times higher for African American women than for Caucasian women, with rates of Puerto Rican and American Indian/Alaskan Natives infant mortality rates similarly elevated above Caucasians (MacDorman & Mathews, 2008). We will now look at other aspects of the modern birthing process to explain why CS rates have continued to increase.

In current practices, hospitals treat delivery as a medical procedure. Coupling that approach with a business perspective, hospitals are decidedly risk averse. At the first sign of trouble, the line of defense taken is to prepare for the worst. Frequently, that includes CS. As obstetrician Jeffrey Ecker noted in an interview, hospitals and doctors don’t typically get sued for CS. “They do get sued for not intervening” (Lake, 2012, para. 17). Yet it is not risk aversion or medical practice alone that drives the increase in CS rates.

In a very complicated insurance and r...

Table of contents

• Cover Page
• Half Title Page
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Introduction: Social, Cultural Norms and Women’s Health—ANNETTE MADLOCK GATISON
• SECTION I Historical Influences on Patient and Provider Perceptions
• SECTION II Breast Cancer, the Silence and the Shame
• SECTION III Make It Taboo: Motherhood, Mothering, and Reproduction
• SECTION IV Sex, Sexuality, Relational Health, and Womanhood
• Epilogue—ANNETTE MADLOCK GATISON
• Contributors
• Index