Anticipating the birth

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The seduction of formal, medicalised preparation is discernible in the

narratives constructed by all the women as they contemplate the birth.

This seduction is rooted in notions of risk, safety and being seen to act

responsibly. The women produce narratives based on their perceptions

of what ‘good’ mothers do, which is to achieve a safe birth without pain

relief, and what their own experiences might entail. The contrasting

threads of resistance and engagement are apparent in many accounts.

These are interwoven with the contradictory implications of it being a

‘natural’ process and therefore one that a body can bear, or has the

capacity to bear. The words ‘natural’, ‘naturally’ and ‘instincts’ are

repeatedly used within the context of anticipating (hoping for) a ‘good’

(easy) birth, and acceptance of what the medical profession and technology

may be able to offer. Hopes then were carefully and tentatively voiced

in these anticipatory narratives. Yet as will become clear in the following

two chapters, in contrast to what is voiced here, many of the women had

thought they would be able to cope with the birth. All the women were

well versed and informed about the different forms of pain relief that were

available to them. Most had ranked them according to their perception of

their acceptability. In the following extract, Gillian anticipates the birth of

her child. The complexities of constructing an acceptable, culturally

recognisable narrative around an experience which is unknown, uncertain

and also inevitable, is clear:

And also you don’t want to be induced either. I’m sure that’s a strong feeling that

one, you want to do it yourself naturally and second, you have a higher incidence

of forceps . . . and pethidine. Talking with a very open mind on the matter, yes,

my instincts say that your body will look after itself . . . it might need a little help

and that’s all. Ehm . . . but at the same time if things go wrong I’m quite

happy . . . I’m going to hospital [name], if things go wrong then . . . have an

epidural, do this, do that . . . then I will. I don’t think, ‘no, I don’t want an

epidural’ . . . in my mind I think ‘no, I shall manage’. I might try this TENS

thing, and I’m quite happy to have some gas and air, so I feel in control. I don’t

like the feeling of being out of control, ehm and I’m not happy about having

pethidine, I think I’d rather have TENS, or gas and air or if things go badly wrong

then I’ll have an epidural . . . pethidine, I think that with a lot of people it makes

them out of control and I don’t like that feeling . . . I think it’s the lack of control

for me, I think I might be physically and mentally so well under that I wouldn’t be

on the planet, whereas with gas and air you can just stop it if you feel you’re getting

out of control and with epidural although physically you lose a lot of control,

mentally you still keep it, in fact probably better because you are not distracted by

the pain . . . But I don’t want to be so pushed over having a natural birth that

I shall be terribly disappointed if something goes wrong and I need help. I want to

try and keep it very open.

In this extract, Gillian rehearses various scenarios, balancing the need to

keep an ‘open mind’ within the belief that ‘your body will look after

itself ’. Interwoven within the account is the acknowledgement that she

might ‘need help’ and doesn’t want to feel ‘terribly disappointed’ if she

does. The complex interweaving of contrasting hopes and anticipated

outcomes were discernible in all the accounts, for example:

I thought right at the beginning when I thought I was having one (twin pregnancy

since confirmed) I didn’t . . . I wanted to try for natural labour . . . well, I would

like (a) go, see if I can do it. But then obviously I’m . . . I’m not . . . I’m not a fool.

I know that if I did get in pain then I’d rather have anything that will help me. I’m

not sort of this person who wants to be perfect and do it all properly. (Sheila)

Yes, it scares me, it does, it does scare me. I’m not too worried about the

pain . . . I think I can handle the pain, but as I said it’s, you know, the thought

of the body coming out of that little hole. I wasn’t quite sure what to go for as

they’ve got so many different things you can take . . . I was going to have pethidine,

’cos I thought I don’t really want a lot of pain if I can help it, but then at the

last antenatal class they said the [hospital name] don’t sort of push that, so now I

am going for gas and air . . . so, but it all depends how it goes, really, itmight be a

piece of cake. (Angela)

I mean my whole instinct is to crawl away and to have it on my own . . . I mean

obviously . . . I would absolutely love to be one of these people that just floats

through and gets by with a few puffs of gas and air . . . And I’d . . . I’d like that but

I’m not going to say that’s what I’m going to do because then I’d be really disappointed

if I need something else . . . I don’t like the idea of an epidural at all but

then I don’t know . . . Imight think it’s the best thing everwhen I cometo it. (Peggy)

If you are tense and nervous and not particularly positive you can create, you

know, problems of anxiety . . . I don’t condemn anybody [but] I think that our

bodies were geared, and made in a certain way that we can give birth naturally.

(Helen – interesting because Helen eventually had to have a caesarean birth)

. . . and I don’t really want any of their drugs. I don’t want to have an epidural or

any of that . . . I don’t mind anything else, but I don’t want that, and I mean, hey,

nature you know. (Sarah)

The women construct narratives by drawing on their own hopes and

fears, grounded in essentialist constructions of maternal bodies, that

women can naturally give birth without medical intervention. At the

same time there is acknowledgment that some ‘help’ may be necessary.

This is couched in terms of trying to retain some ‘control’, and trying to

‘enjoy’ the experience. Yet these hopes are tentatively voiced. Implicit

within the extracts is an awareness that even how women achieve birth

has implications for perceptions of the type of mother they will be: a

‘good’, ‘perfect’ mother, who gives birth ‘properly’, or a ‘guilty’ mother

who ‘fails’ and needs medical intervention. It is interesting that whilst a

‘natural’ birth (without drugs) is seen as the best type of birth, engaging

with some form of pain relief is, at the same time, seen as offering a means

of retaining control over the birth.

The hospital, as a place in which births are managed, is perceived to

offer both the possibility of a natural birth and at the same time the

possibility of a medically assisted birth enabling women to retain ‘control’:

indeed, ideas around these are conflated. Loss of control for these

women, who have experienced dimensions of agency in relation to the

world of work, was a particular concern and one that is class-related

(Lazarus, 19 97). Pain relief, then, becomes potentially liberating, offering

a means of retaining control. And whilst the extracts above suggest that

women anticipated that control and some autonomy could be retained

within the context of ‘keeping an open mind’, the medical profession were

still perceived to be the experts, experts with ‘rules’ which might have to be

followed, as Lillian says:

Yes, when I’ve found out that . . . if they’re happy about people changing positions

and things like that, because somebody was saying to me that

sometimes they get you into a position that they want you to be in rather than

you want to be in and you know, like, so I want to find out [the] rules.

Similarly, Gillian comments:

You’re going to be stuck with the medical way of doing things, but then I’m

happy to go along with that. I don’t know what to do if I have problems, I want

them to tell me what to do, and it’s only if everything goes smoothly and you

don’t have any problems that you should be perhaps allowed to do what you

want to do.

These constructions reinforce notions of expert, authoritative knowledge

and associated power. Yet the women did not resist such notions but

colluded and engaged with them. Indeed, the ways in which the

participants operated with a hierarchy of forms of pain relief and saw

potential take-up as a means of giving them control, showed the women

to be sophisticated consumers rather than passive victims. These findings

are also echoed in research from the USA and Canada and increasingly

may be less a phenomenon of class position, but rather a demonstration of

the ‘success’ of medicalisation and technological birth (Fox and Worts,

1999; Davis-Floyd, 19 92 ).

In many societies, powerful moral and legal sanctions exist for those

who are regarded as not preparing appropriately to become amother, or

more importantly, to be acting irresponsibly, and putting the life of their

unborn child ‘at risk’. The exercise of agency and choices made by the

women in this study must, then, be considered within the context of a

powerful medical/health profession and associated authoritative knowledge

and practices. These are then reinforced through culturally and

socially circumscribed beliefs in appropriate ways of becoming and

being a mother. The anticipatory narratives constructed during the

antenatal (prenatal) period were both complex and, apparently,

unproblematic. Women presented accounts in which they spoke of

their appropriate actions around preparation. They attended antenatal

clinics, went to parent-craft classes, had ultrasound scans and changed

their diets and socialising habits. Interestingly, having claimed not to

have expectations of what being pregnant would be like, the women

produced narratives which were built upon shared assumptions and

stereotypes of what pregnancy entailed. When the women described

less enjoyable aspects of their pregnancy, they quickly reverted to language

they perceived to be more acceptable. In the following extract

Linda, apparently sensing that the account she has narrated has been

rather negative, containing lengthy descriptions of how she did not like

the physical changes to her body and her sense of her body being ‘fat’,

concluded in the following way:

But I know that there’s going to be a bundle of joy at the end of the day and that’s

what I’m looking for . . .

To talk negatively about the pregnancy was construed as not preparing

appropriately, not being a ‘good’ mother-to-be, risking being

seen as irresponsible. In the following extract, Rebecca talks about

not passing her ‘apprehensive’ feelings about the pregnancy on to her

unborn baby:

But I’ve never ever throughout the whole pregnancy, and I hope I don’t, thought,

oh this is a mistake and I don’t like the baby, or anything like that. I’ve always kept

positive and talking to him or her and that kind of thing, because even in the

womb, well I think they can tell if you go off them and feel vindictive towards them

in any way, well not vindictive – it’s too strong a word, but . . . and I don’t want to

ever do that . . .

Rebecca’s own ‘policing’ of her account is interesting here. But showing

the complexities and contradictions within narratives, Rebecca had

earlier commented:

So I was just in the middle of changing my mind when I fell pregnant, so I did have

mixed emotions actually. To start with it was quite difficult, and also the hormones

bit I think made a difference, it does, doesn’t it? And so I think I was

probably quite grumpy and tearful and a bit moody, as well as all these other very

real worries and that kind of thing. So I was excited but had reservations as

well . . . in fact that was the good thing because when I first started telling people

everybody was so pleased, so pleased, that it made me pleased. That was actually

the turning point for me because up until then I’d been not exactly negative but

very, very apprehensive, I mean really apprehensive. And it was when I started

telling people that I actually felt better about it, because everybody thought,

I don’t know, I suppose they thought I would be a good mother or something,

because I do take it very seriously, and I was quite pleased that they obviously have

confidence in me.

Positive reactions to Rebecca’s disclosure of her pregnancy to family and

friends help her to envisage her self as a mother. She is reassured by their

perception of her capacity to be a ‘good mother’. The interactional

dimensions of selves are apparent here and will be returned to in subsequent

chapters.