Keeping it Together, Falling Apart and Everything in Between: A Phenomenology of Women's Experiences of Childbirth Open Access

Hall, Priscilla Joy (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/h989r3335?locale=en
Published

Abstract

The childbirth experience is a meaningful life event that affects a woman's sense of herself as a human being and a mother. The positive or negative quality of birth has a profound effect on women's emotions following labor, with both short- and long-term effects on women's wellbeing and relationship to the newborn. There is little research on childbirth as a holistic, complex experience of mind-body in relationship to the environment, time and space. The purpose of this study was to examine childbirth in this complexity, with all of the nuances of emotion, thought, and sensation that create the experience using descriptive phenomenology, a method to study human experience. Eight essentially healthy women of different ethnicities and socioeconomic status with spontaneous term vaginal births were interviewed 3-12 weeks after the birth, with a second interview conducted 6-12 weeks later. The phenomenon of childbirth was an experience of being a body and a self, the physical and non-physical elements of the human being with dynamic changes in emotions, physical sensations and human relationships moment to moment across the process. Women experienced contrasting states of being with co-existing positive and negative emotions. There were four pivotal elements that changed the quality of the experience. These were confidence in the capacity of the body and the self, physical and emotional comfort, positive or negative human connections and agency, the ability to act on your own behalf to achieve well-being. These elements did not act singularly but rather influenced each other in a complex web of interactions. This study has demonstrated the importance of developing maternity care services and education directed at supporting confidence, comfort, and agency in order to promote wellness in the childbirth experience and support the optimal function of the normal, physiological childbirth process.

Table of Contents

Table of Contents

Page No.

Chapter 1: Introduction and Specific aims

1

1.1 Specific Aims

7

1.2 Theoretical Frameworks

8

1.3 Summary

10

Chapter 2: Background and Significance

11

2.1The Literature Review From a Phenomenological Stance

11

2.2 The Labor Experience: Holistic and Paradoxical

11

2.3 What is Known About Important Elements of Birth

12

The experience of pain

12

The experience of positive and negative emotion

15

The experience of human others

18

The experience of professional caregivers

20

The experience of feeling powerful

21

The experience of feeling comfort

24

The experience of medical interventions

25

The experience of the birth setting

28

2.4 What is not Known about the Birth Experience

31

Chapter 3: Method and Design

32

3.1 Purpose and Design

32

3.2 Phenomenology: Philosophy and Method

32

Important concepts in phenomenology: the life world

33

Important concepts in phenomenology: intentionality

34

Important concepts in phenomenology: reduction

34

Important concepts in phenomenology: the four existentials

35

Corporeality

35

Temporality

35

Relationality

36

Spatiality

36

The research approach: descriptive or interpretive

37

3.3 Population and Sample

38

3.4 Recruitment

39

3.5 Data Collection

42

The Phenomenological Interview

43

Bridling

44

3.6 Data Management

48

3.7 Data Analysis

49

3.8 Trustworthiness

54

3.9 Summary

56

Chapter 4: Keeping it Together, Falling Apart of the body-self in Space, Time and With Others

57

4.1 Keeping it Together and Falling Apart of the Body and the Self

57

4.2 The Phenomenon of Labor: Keeping it Together, Falling Apart and Everything in Between

58

4.2 Keeping it Together, Falling Apart From Pain

60

Working with Pain

61

Freedom of Movement

61

Knowledge

62

Falling Apart From Pain

63

Slow Progress

63

Too Fast And Furious

64

No One Is Listening-Provider Untrustworthiness

65

Changing Location at the End Of Labor

65

4.3 Keeping it Together, Falling Apart Around Comfort and Discomfort

66

Being Comfortable

66

Being Uncomfortable

67

I-do-not-know-discomfort: what exactly is it?

67

Restricted movement and discomfort

68

Body shame and discomfort

68

The physical space and discomfort

69

4.4 Keeping it together, falling apart and confidence: Will my body work?

71

Time and the perception that body is capable

71

Laboring with the calendar: will it start on the right day?

72

Uncertainty in early labor: the body won't keep a schedule

74

Starting labor at the perfect time: luck or a self fulfilling prophecy

75

Contrasts in time: hospital versus home birth

76

Hospital time: the clock is front and center

77

Homebirth: different space, different perspective on time

80

4.5 Keeping it Together, Falling Apart with Emotion: the Highs and Lows of Labor

82

The passing of time and emotion in labor

83

Tired of pregnancy, longing to meet the baby: anticipating labor

83

Hope, confidence and worry at the beginning of labor

84

I think I can do this...maybe I cannot: moving into the middle of labor

85

I know I am strong but this is really hard: being in the second stage

86

Triumph and exhaustion: the moment of birth

86

4.6 Keeping it Together, Falling Apart and Agency: Knowledge, Vulnerability and Determination

87

Knowing what your body-self wants

88

What does the body-self know?

89

Outside knowledge: childbirth education

89

Finding the right knowledge: you have to know where to look

91

Inside knowledge: life experience

92

Inside knowledge: knowledge of the body

93

Vulnerability and agency

94

Determination: having a voice and a plan

96

Using one's voice: asking or not asking

97

Making a plan: a form of asking

98

What happens to agency if induction is the plan

101

Asking for an epidural: the unexpected effect of pain relief

103

Agency and feeling desperate: taking matters into your own hands

104

Agency and spatiality: who owns the birth space?

107

4.7 Keeping it Together, Falling Apart Around Others: Relationality in Labor

108

The body-self and family

109

Agency and family

110

The body-self and the doula

112

The body-self and professional caregivers

113

The range of caregiver interactions: connected, disconnected, alienated

114

4.8 Summary

118

Chapter 5: Discussion

120

5.1 The Phenomenon Of Labor: Moving Between Keeping it Together and Falling Apart

120

5.2 Keeping it Together, Falling Apart of Mind and Body

121

5.3 Keeping it Together to Work with Pain: Comfort, Connection, Agency and Confidence

123

5.4 Comfort and Discomfort in the Keeping it Together Falling Apart Continuum

125

5.5 Confidence In Motion: Between Trusting the Body and Feeling Uncertain

127

Time and the capacity of the body

128

Birth In No-Time: Out Of The Hospital

130

5.6 Emotion in the Keeping it Together Falling Apart Experience

132

5.7 The Ups and Downs of Agency: Trying to get What you Want in Labor

134

Information and agency

134

Determination, confidence and agency: creating a birth plan

136

Asking for what you want and feminine norms

136

Agency and intersectionality

137

Vulnerability and agency: speaking up when you are lying down

139

Medicalization and agency

139

5.8 Keeping it Together and Falling Apart Around Others

142

Keeping it together, falling apart with family

143

The effect of doula care

145

Relationships with health care providers

146

The provider-patient relationship and time-pressure

147

Am I not a person? Falling apart and untrustworthy relationships in labor

149

5.9 Keeping it Together, Falling Apart and Chaos

150

5.10 Recommendations

151

5.11 Limitations

154

5.12 Summary and Conclusion

157

Table 1: Recruitment Plan

158

Table 2: Participant Characteristics

159

Table 3: Details Of The Birth Experience 1

160

Table 4: Details Of The Birth Experience II

161

Appendix A: English Informed Consent

162

Appendix B: Spanish Informed Consent

166

Appendix C. English And Spanish Interview Guides

170

Appendix D. Code Book

173

Appendix E. Summary of Emotions for Anita

183

Appendix F. Descriptions Of The Moment Of Birth

187

Appendix G. Comparisons Of The Pain Experience

190

References

202

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