Keeping it Together, Falling Apart and Everything in Between: A Phenomenology of Women's Experiences of Childbirth 公开
Hall, Priscilla Joy (2015)
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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