Birth Rites and Rights

Fatemeh Ebtehaj, Jonathan Herring, Martin Johnson M.A., PhD., F.R.C.O.G., Martin Richards, Fatemeh Ebtehaj, Jonathan Herring, Martin Johnson M.A., PhD., F.R.C.O.G., Martin Richards

• Publisher: Hart Publishing
• Year: 2011
• Print ISBN: 9781849461887
• eBook ISBN: 9781847318572
• Edition: 1
• Topic: Law
• Subtopic: Medical Law
• Index: Law

This multi-disciplinary collection of essays from the Cambridge Socio-Legal Group is concerned with the varying circumstances, manner, timing and experiences of birth. It contains essays from a wide range of disciplines including law, medicine, anthropology, history and sociology, examining birth from the perspectives of mother, doctor, midwife and father. Questions considered in the book include: who has power during the birthing process? How has the experience of birth changed over time? Should birth mark a significant change in the legal status of the foetus? What is the proper role of birth registration? What role, if any, do fathers have in the birthing process? What legal rights should the woman have to refuse treatment during the birthing process? What is the significance of changes of the age at which women give birth? This stimulating collection of papers provides new insights into one of life's most momentous moments.

Part 1:

Experiences and Rites of Birth

1

Becoming a Mother: Continuities and
Discontinuities over Three Decades

ANN OAKLEY, MEG WIGGINS, VICKI STRANGE, MARY SAWTELL
AND HELEN AUSTERBERRY

I. INTRODUCTION

GIVING BIRTH FOR the first time is part of a broader socio-cultural transition, that from non-mother to mother. The experiences of women in pregnancy and childbirth are part of a complex of factors influencing the shape and outcome of that transition. Maternity care policies and practices, themselves subject to historical and cultural change, operate in a context of continuities and discontinuities in women’s lives. This chapter offers one perspective on the transition to motherhood through the particular lens of two research projects using a similar methodology but separated by three decades. The aims of the chapter are, using data from these two studies, to look at some of the ways in which women’s experiences of pregnancy and childbirth in the UK have changed or remained constant since the 1970s. Our goals in conducting a ‘repeat’ study were to look at the impact on women’s experiences of the substantial policy and practice changes in the management of childbirth that have occurred since the 1970s. An important context for these changes is shifts in women’s position and in family life. We were particularly interested in how influential or otherwise experiences of the maternity care system itself are in shaping how women feel about becoming mothers today as compared with in the past.

NOTE ON THE CHALLENGES OF REPEAT STUDIES

The definition of a ‘repeat’ or ‘restudy’ is: ‘…a deliberate intent to repeat insofar as possible a previous research study using the same research design and methods to investigate similar theoretical concerns usually with the goal of better understanding social change’ (Davies and Charles, 2002, p. 1). Researchers in the social sciences have not paid much attention to replication research, in part perhaps because of a funding bias against knowledge accumulation (Klein et al., 2000). Uncritical replication of exactly the same methods is usually not a feature of such studies (Neuliep, 1991). For example, particular research or interview questions often need to be reworked to reflect changes in language or the framing of issues; practices of measuring such dimensions as social class and ethnicity also develop and these cannot be ignored in new studies. The important constant is the theoretical and conceptual framework which is common to both original and repeat studies. With respect to the two studies discussed in this chapter, the framework is one which locates women’s transition to motherhood in the context of studies of life transitions generally, but particularises the contribution of social and health care factors to the outcome of this transition, defined as how women feel about their experiences of pregnancy, childbirth, and early motherhood.

II. BACKGROUND: THE TWO STUDIES

The original study was carried out by one of us (AO) in 1974–9. A sample of women having their babies in a West London hospital in 1975–6 was interviewed twice in pregnancy and twice in the early postnatal months. The aims of the project were to gather first-hand accounts of the process of the transition to motherhood at a time when research of this kind was scarce; and to examine links between social and health care factors, on the one hand, and the ‘outcome’ of the transition to motherhood, on the other. The main publications from the project were two books: Becoming a Mother (Oakley, 1979a), later republished as From Here to Maternity (Oakley, 1981, 1986), which used mainly qualitative interview data; and Women Confined (Oakley, 1980), a more analytic approach to the data, which presented a theoretical model of childbirth as a life transition. Other publications from the project included an extended literature review looking at the conceptualisation of women as mothers in psychology, sociology and medicine (Oakley 1979b); a focussed paper on medical and social factors in postpartum depression (Oakley & Chamberlain, 1981); and reflections on the ‘advice’ literature then available for first-time mothers (Oakley, 1982).

The second study, which is still ongoing, has been designed to replicate as far as possible the methods and intentions of the first study. However, unlike the original study, it is a team effort, led by Vicki Strange and Meg Wiggins, with all the authors of this chapter contributing. The study began in 2007 and will finish in 2011. The sample of women has been recruited from the same hospital using similar methods as in the original study, and, as before, two pregnancy and two post-natal interviews have been carried out. But because the relationship between motherhood and employment has changed significantly since the 1970s, this second study is being extended to allow for a fifth interview when the babies are 18 months old.

The first study (S1) recruited 66 women, of whom 55 continued with their pregnancies and were interviewed four times. The second study (S2) recruited 71 women, of whom 58 contributed data at all four interview points. Table 1 shows the demographic profile of the two samples.

Table 1: Demographic Profiles of Women in S1 and S2

	S1[N=55]	S2 [N=58]
Average age	26 yrs	31 yrs
Partner status: – Married & living together – Living with partner (not married) – Has partner, but not living together – Single (no partner)	87% (48) 13% (7) 0 0	50% (29) 34% (20) 10% (6) 5% (3)
‘Country of origin’: Britain [S1]; ‘inside UK’ [S2] Elsewhere: Ireland/N.America [S1]; ‘outside UK’[S2]	84% (46) 16% (9)	50% (29) 40% (29)
Ethnicity: – White British – White other [mainly other European] – Mixed – Asian/Asian British – Black/Black British – Chinese/other	100% White British/other	43% (25) 29% (17) 4% (2) 9% (5) 12% (7) 4% (2)
Social Class: * – I Professional occupations – II Managerial and technical – IIIN skilled – non manual – IIIM skilled– manual – IV partly skilled – V unskilled – Unclassified (students)	4% (2) 27% (15) 62% (34) 0% (0) 7% (4) 0% (0) 0% (0)	7% (4) 52% (30) 19% (11) 5% (3) 5% (3) 2% (1) 10% (6)

* Social class of study women (using the conversion between Social class and NS-SEC operational categories)

The picture in Table 1 reflects population changes since the 1970s and also the different criteria used to select the two samples. S1 recruited only married or cohabiting women born in Britain, Ireland or the USA; S2 included single women and same sex partnerships and women conversant in English irrespective of country of birth. Table 1 shows that the women in S2 are more culturally diverse and more likely to be single than those in S1; they are also older – 31 years compared with 26 years. The S2 women’s occupational profiles indicate a somewhat more middle class sample – 59% of S2 women are social class I or II, compared with 31% of S1 women. These differences in the populations of women taking part in the two studies reflect broad social changes since the 1970s; they are also germane to some of the findings we discuss below.

Both samples of women were recruited directly from hospital booking clinics, and interviewed as soon after this as possible (S1: 26 weeks before the birth, S2: 24 weeks before), and then as close as was feasible to one month before birth and six weeks and five months after birth. All the interviews were transcribed and the qualitative and quantitative data analysed using various standard techniques.

Many types and levels of comparison can be made between the findings of the two studies. In this chapter we limit ourselves to a brief discussion of five themes: confirmation of pregnancy and choice of maternity care; expectations about childbirth and patterns of birth ‘management’; postnatal care; social support; and information resources.

III. BECOMING A PREGNANT PATIENT

The ‘medicalization’ of reproduction and the absence of choice for childbearing women as to place and type of care were issues highlighted in 1970s debates about maternity care (see eg Arms, 1975; Cartwright, 1979; Zander & Chamberlain, 1984). Since then much has changed. The presence of a ‘consumer’ voice in health care is now accepted as legitimate (King’s Fund Centre, 1993; Expert Maternity Group, 1993). The latest UK policy statement promises choice with respect to place and type of antenatal, intranatal and postnatal care, continuity of care, and a strategy ‘that will put women and their partners at the centre of their local maternity service provision’ (Department of Health, 2007, p. 7) This is a very different rhetoric from the ‘doctor knows best’ tone of the policy statements that underpinned the development of the maternity services in the 1970s and before.

In S1, all the women visited their GPs in early pregnancy to have their pregnancy confirmed and arrange their maternity care. Although some GPs provided antenatal care in their surgeries, most referred women to hospital. Many women either knew or suspected they were pregnant before visiting the doctor, but pregnancy tests could not be purchased over the pharmacy counter, and this first visit to the GP was therefore important, though not always successful, as an official medical confirmation:

(S1 – ‘DJ’, 23 years, Jewellery assembler, married)

I told her (GP) my symptoms – that I wasn’t feeling up to scratch. She asked me if I’d missed my periods and I said yes. She said it is possible that you could be pregnant. She looked through my records and said I’d been regular since I’d started so I was probably pregnant: come back in two months time…I was, not upset, but dubious I suppose that she didn’t examine me or anything. She just took it for granted. But it still didn’t ease my mind. I wanted to know myself. I wanted to tell my husband. He knew that I might be, but he said to go and find out: we didn’t want to build our hopes up. But all I could say was ‘probably’ when I came back.

In S1 a minority of women – 38% – were examined at this first consultation. Just 16% received any advice about pregnancy. No GP suggested the possibility of a home birth, though 9% of the women said they had considered this as a possible option. Most women – 58% – were simply told that they would have their baby in a particular hospital; 61% were given no choice (or information about the options) as to who (GP, hospital, local authority clinic), would do their antenatal care.

In contrast, almost all the women in S2 confirmed their pregnancy themselves with over-the-counter pregnancy tests. These are able accurately to confirm a pregnancy at four weeks compared to the test used in the 1970s which required women to be around eight weeks pregnant. Consequently women in S2 began their new ‘pregnant’ identities earlier, often before they were aware of any pregnancy symptoms. Earlier confirmation meant that women in S2 were more likely to be aware of early miscarriages and anxiety about this dominated many women’s accounts of the first trimester. As it was for women in the 1970s study, the main function of the visit to the GP was to obtain a referral to the hospital which would provide most of their care. Also as in S1, these consultations were commonly very short, and it was rare for women to be given guidance by their GPs to as to specific sources of information. No S2 women reported that their GP discussed options with regard to the types of care available or where they might deliver their baby (eg home birth, birthing centres). A few women were clear before meeting with the GP that they wanted to go to the study hospital for their antenatal care, and a few, who did not live near the hospital, went to great lengths to get a referral. But, most commonly, the GPs listed a few local hospitals and then highlighted the study hospital as a good option because it was local, most women in this area went there, or they knew of satisfied patients. None of the women reported being given any factual information by their GPs that might help them make an informed choice about which hospital they should ‘choose’, though in some cases they did access this themselves via the internet:

(S2, ‘GM’, 33 years, Marketing executive, married)

I think there was a (study hospital) website, or an NHS website that you could access all the hospitals through and I remember I’d read about certain areas and then I read about (study hospital) and a number of other hospitals. But I mainly, apart from just the information that...

Table of contents

• Cover
• Title
• Copyright
• Acknowledgements
• Contents
• Notes on contributors
• Introduction: Birth Writes
• Part 1: Experiences and Rites of Birth
• Part 2: Status and Consequences of Birth
• Part 3: After Birth
• Part 4: Timing of Birth
• Index