Rethinking Women's Birth Experience: Medical Frameworks and Personal Narratives

Article excerpt

This paper emerges from my on-going research into birth experience and lay support people in the birth room, and presents findings from two recent projects interviewing birthing women and midwives. In the contemporary health experience of individuals in developed countries, individual responsibility for health outcomes has become an increasingly prevalent aspect of public health discourse. The proliferation of information sources for health information, for example, in programmes such as Good Medicine and magazines such as Good Health, as well as via the Internet, has also led to an increasing expectation of individual self-surveillance. In response to these trends, general understandings and definitions of health have become increasingly medicalised. I contend that the 'healthy body' has become synonymous with the 'managed body', where discourses of control drawn from biomédical certainties are emphasised and privileged. I am specifically interested in how this may impact on women's birth experiences where accurate and plentiful medical information cannot prepare women for the psychical or affective aspects of giving birth. Recent Australian research indicates that women's dissatisfaction with birth 'service delivery' is increasing. In this paper I consider what role the internalisation of medicalised frames for corporeal experience may play in this marked dissatisfaction level. I ask whether feminist theories of embodiment can be usefully used to contest prevailing models for understanding women's experiences of birth.

Susan Johnson's A Better Woman published in 1999 offers a graphic account of postnatal damage and comes with an important and I think symptomatic inscription on its cover:

Some of my close friends will be learning for the first time in these pages the full story of what happened to me after the birth of my sons. I did not wilfully deceive them. It was that I could hardly bear to have been such a failure at having a baby.1

Johnson is indicating here that the medical and physiological story to be revealed between those covers is one that she has not told her friends; that they will be learning of the extent of her physical trauma for the first time in the published form. While A Better Woman does go on to detail some of those pains, and in quite graphic detail, the inscription implies that medical stories of birth, as well as cultural ones, are not easily told, and not easily heard; an argument that has also been posited by Delia Pollock2 and by Tess Cosslett.3 In this paper, I focus on the operation of medical narratives in birth experience. In particular, I talk about how women's 'medical' knowledge might impact on their physiological experiences. This paper is a speculative one - I am conducting a study in which I interview women about what they knew and what difference they think it made to their birth experience. This paper explores the various cultural and ideological configurations that I think are at stake in the prevalence of medical definitions of birthing. It has been well established by feminist activists and scholars that such models impact on women in the delivery of services, the cascade of intervention and in their satisfaction. But I am interested in considering whether these knowledges, with their expanding reach, become part of embodied experience and thus have material physiological effects in birthing.

I look at this proposition through two different, interrelated lenses; the first is the increased expectation that we perform as good 'health consumers' which I speculate has very particular effects on how women view birth. The second is the pre-eminence of biomedical information that women use as preparation for birth in the contemporary Australian context. In this paper, I draw on two research projects I conducted with Dr Kay Souter from La Trobe University that explored birth experience; one gathered midwife accounts of birthing experience and antenatal preparation; and one gathered women's accounts of postpartum health and what information relied upon. …