Therapeutic Arts in Pregnancy, Birth and New Parenthood

Susan Hogan, Susan Hogan

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000165128
• Edition: 1
• Topic: Arte
• Subtopic: Tecniche artistiche

Therapeutic Arts in Pregnancy, Birth and New Parenthood explores the use of arts in relation to infertility, pregnancy, childbirth and new parenthood. It is the first book to bring all these subjects together into one accessible volume with an international perspective.

The book looks at the role of the arts in health with respect to the pregnancy journey, from conception to new parenthood. It introduces readers to the ways in which art is being used with women who are experiencing different stages of childbearing – who may be unable to conceive and are struggling with infertility treatment, or who experience miscarriage and loss, a traumatic birth, or grief over the loss of a baby. It also elucidates how art-making offers a means for women to express and understand their changed sense of self-identity and sexuality as a result of pregnancy and motherhood.

The book has an international compass and is essential reading for arts therapy trainees and arts in health courses and will also be of interest to other health professionals and artists.

1 Arts in health

Pregnancy, birth and new parenthood

Susan Hogan

Art making offers a means for women to express and understand their changed sense of self-identity and sexuality as a result of pregnancy and motherhood. The aim of this book is to introduce readers to the various ways in which art is being used with women who are experiencing different stages of childbearing – who may be unable to conceive and are struggling with infertility treatment, or experience miscarriage and loss, or are facing other issues of adjustment. This work can include a myriad of factors: ambivalence, pre-natal anxiety, unhappiness and disorientation, or even dread, as well as rekindled feelings of grief for lost parents, unresolved feelings towards mothers and others, feelings of abandonment where the progenitor has fled, birth trauma, or the grief of the loss of a baby. Art can also be of help in exploring and supporting family relationships with partners involved and in supporting new families, as the final chapter in this book explores.

Metaphor and symbolism are often used around contested sites of meaning, and art making can also provide the opportunity to analyse and challenge social ideas and oppressive discourses (Hogan 1997).

This book wishes to acknowledge that ideals around pregnancy and childbirth are highly contested, that this contestation, coupled with the very liminality of the event itself is challenging, if not potentially destabilising for new mothers and their partners. Or, to put it another way, women are subject to new pressures and constraints that are potentially dislocating. Having been led to expect success and joy, some women may experience conflicting feelings and memories that have no space for expression, making pregnancy or new motherhood a challenging time. Moreover, women’s actual perinatal experiences (which may be very far from imagined ideals) can be disavowed by societal expectations of maternal competency and bliss (Hogan 2017).

The English political activist and law reporter Vanessa Olorenshaw (2016) has pointed out that motherhood demands interdependence and sits uncomfortably with the dominant neo-liberal ideology of ‘self’ and ‘individualism’ as the core objects of a happy selfhood. Although childbirth is a universal experience, it is also culturally mediated – it is experienced through culture. Current fashion demands women should have thin and muscular bodies. Some women can find pregnancy distressing because of the transformation of their body shape away from such an ideal, their feelings of self-esteem being undermined. Chronic illness is often exacerbated by pregnancy. Previously fit and healthy women can develop debilitating conditions during pregnancy such as pre-eclampsia (marked by swelling and high blood pressure). There is sometimes lack of understanding about bodily processes among pregnant women and new mothers. For example, when breastfeeding a new-born baby, women can experience uterine contractions as the baby suckles (this is quite normal), but one new mother I worked with thought this reaction was “perverted” and this false belief had caused her great distress. Our bodily autonomy is challenged: as our baby cries out, we feel our breasts filling with milk at the baby’s command. The sheer profound dependence of the infant is dismaying. The ‘I experience that too’ aspect of group work is intensely valuable for mutual support of new mothers. There are strong cultural taboos preventing women from expressing their feelings, not least the fear that their children may be taken away from them. One of the advantages of working pictorially is that the revealing image allows the expression and acknowledgement of denied or unrealised feelings – it enables women to show what they cannot say and learn what they feel, but find difficult to acknowledge or grasp.

What women experience during pregnancy and childbirth is not merely psychological, it is societal (structural). Structural issues are at play during the period of pregnancy: women may be subject to increased regulation, depending on their specific milieu. This might include interference in women’s activities (what she may or may not do whilst pregnant), dietary intake (what she may or may not eat or drink), even what clothes are deemed appropriate to wear. Unfortunately there is no consensus on these issues, so women are subject to conflicting advice, sometimes a bewildering array of conflicting guidance from family members and health professionals. This can result in conflict and tensions between members of a family about what is best.

The Nigerian writer Chimamanda Ngozi Adichie gives some words of hope and encouragement on this topic:

Be a full person. Motherhood is a glorious gift, but do not define yourself solely by motherhood. Your child will benefit from that … Everybody will have an opinion about what you should do, but what matters is what you want for yourself, and not what others want you to want … In these coming weeks of new motherhood be kind to yourself. Ask for help. Expect to be helped … Give yourself room to fail. A new mother does not necessarily know how to calm a crying baby. Don’t assume you should know everything.

(2016, pp. 9–11)

Different cultures treat pregnant women differently. Here in the UK, women report being touched more (their enlarging stomachs touched) and new mothers are fair game for conversations about their new babies from an selection of strangers with whom they’d not previously spoken. In this way bodily privacy and the negotiation of public space is altered for women who are pregnant or new mothers. Indeed, a new mother can find hitherto simple tasks (such as getting on a bus and then shopping) have become extremely difficult. I found it impossible to get my buggy on a bus in London, I recall, as I was simply elbowed out of the way by determined commuters in their frantic scrum! No concession was made to the fact that I was encumbered. In contrast, in many parts of France, people with babies or young children may find themselves ushered to the front of queues and given preferential boarding on forms of transport.

In many relationships in which there has been relative equality between partners, inequality starts to develop when the first baby is born. Women often lose or reduce their paid employment and become semi-dependent on their partners, possibly for the first time in their relationships. Loss of employment at this time can result in late-in-life poverty for many women who make insufficient pension contributions throughout their careers. These decisions around early parenting have lifelong consequences. The Economist magazine put it like this, ‘Having children lowers women’s lifetime earnings, an outcome known as the “child penalty”’ (The Economist Twitter feed, 17 November 2018). Women having time out of paid employment, or reducing their employment then puts men at the forefront of the career/wage-earning stakes within the relationship. Men may have the primary power position in terms of making an economic contribution from then on (Banyard 2011). Subsequently, it is often the man’s career that is prioritised, even necessitating possible geographical relocations to seize new opportunities, which can further dislocate wives and partners from their support networks, as they become ‘trailing spouses’. Women who stay on at work are likely to be subject to an array of discriminatory behaviours and lack of career progression. It doesn’t have to be like this, and the more we move to genuine co-patenting the better it will be for women and men alike. A European survey summarised that ‘the birth of the first child constitutes a major and irreversible change in focus, priorities, and life-course. One never sees life as one did before becoming a mother’ (Stevens, de Bergeyck & de Liedekerke 2011, p.11). Stunningly, in the same report, only 50 per cent of husbands are recorded as helping ‘regularly’ with domestic work (housework and childcare) by 4,200 women who answered this question; nevertheless, the Second European Quality of Life Survey notes increased levels of ‘life satisfaction’ for couples with children (Stevens et al. 2011, p. 32).

The way women give birth varies, but in many cultures there has been a strong move towards hospital births as customary. Until the 1960s the British Medical Journal was advocating that for normal pregnancies the best place to give birth was in the home, (The British Medical Journal in 1954 was still willing to ‘arbitrate decisively’ that ‘the proper place for the confinement is the patient’s own home’; BMJ 24 April 1954, cited Oakley 1984, p. 215). Today the overwhelming majority of births take place in hospitals, even if entirely normal. This means that women are taken into a medical environment. Once in the medical environment, women are more likely to be subject to ‘routine’ medical procedures that would not be, or would be less likely to be, implemented in the home. For example, so-called ‘routine induction’ is common, to precipitate and speed-up childbirth. It is justified to prevent ‘bed blocking’, an insidious dehumanising euphemism that prioritises hospital timetables over letting the labour take its natural time – women vary and so do the length of our labours.

Routine induction is presented as a normal and usual procedure and its risks and benefits are rarely properly articulated and discussed with the labouring woman. Induction is linked to the likelihood of further medical procedures and higher levels of pain. Furthermore, women can be made to feel unreasonable if they decline offered interventions. However, induction is linked to an increased rate of episiotomy and caesarean section, which is a serious and life-threatening surgical procedure. Episiotomy is the cutting of the skin between the vagina and anus with surgical shears and can cause long-term discomfort and pain and short-term agony. Rather than being used in extreme emergencies, C-sections account for a large proportion of hospital births today. A national survey carried out in Italy between 2003 and 2017 found that episiotomy had been performed ‘by deceit’ on 1.6 million women: 61 per cent of whom declared they had not given informed consent. Of these women 15 per cent considered it to be ‘a form of genital mutilation’ and 13 per cent regarded it as a ‘betrayal of trust’. The same survey revealed that four out of ten women (41 per cent) were subjected to practices ‘that violated their dignity and psychological integrity’. This survey was useful in revealing a level of obstetric intervention that was seen as being of clear concern. Indeed 21 per cent of the women in Italy considered themselves to have been subject to ‘obstetric violence’ whilst giving birth. The proportion of these women to be diagnosed as being depressed in new motherhood is not reported (Bastatacere National Survey 2017).

The World Health Organization has also reported on disrespectful and abusive treatment experienced during childbirth globally, highlighting particular situations including:

• Failure to get informed consent for procedures.
• Lack of confidentiality.
• Gross violations of privacy.
• Coercion to undergo medical procedures (including sterilisation).
• Outright physical abuse.
• Profound humiliation and verbal abuse.
• Refusal to give pain relief.
• Neglect of women during childbirth (with the consequence of women suffering life-threatening, avoidable complications).
• Refusal to admit women to health facilities.
• Detention of women and their infants after childbirth due to their inability to pay.

The World Health Organization has produced the following statement on the prevention and elimination of disrespect and abuse during facility-based childbirth: ‘Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful care’ (WHO 2014). The physiological challenges involved, even for straightforward, uncomplicated pregnancies and births, should not be underestimated and the United Nations has expressed concern about preventable deaths (UN 2010). In the UK, stillbirth rates and maternal mortality is disproportionately high for black women, due to a combination of factors (Muglu et al. 2019).

To dismiss women’s reactions to pregnancy, childbirth and new motherhood as merely neurotic is unacceptable and compounds abuses of power and discriminatory cultural norms. In previous work, I have explored the ‘mother blaming’ aspects of various psychological theories, as women are positioned as the problem – first, we are positioned as deficient if we don’t bounce back immediately from traumatic births and destabilising circumstances, and second, we are responsible for our children’s attachment anxieties should we dare to venture out without our infants. There is no such thing as a good enough mother; women are condemned in much of the published psychological theorising, which is fundamentally oppressive; examples of criticism even include ‘too good’ mothering (Hogan 2012). Mother blaming is endemic and Caplan sardonically sums it up. I paraphrase: sit too close to your child and you are smothering and invasive; sit too far away and you are narcissistic, remote and rejecting, or possibly ‘castrating’. Of her clinical experience she wrote: ‘We found that mothers were blamed for virtually every kind of psychological or emotional problem that ever brought any patient to see a therapist (Caplan 2007, pp. 592–593).

In a polemical outburst Olorenshaw (2016) puts it like this,

And the children? Hoodlum? Mother was depressed. Autism? Mother consumed a glass of wine in pregnancy. Addiction? Mother was detached in infancy. Married to a...