There are many different definitions of health, which vary from the lack of disease, to the ability to participate in the normal activities of life; there is currently more of a focus on wellbeing rather than just using the term health (Schickler 2005; Tomlinson and Kelly 2013). Health is one part of wellbeing and just because a person has a disease does not mean that they will auto-matically feel that their wellbeing has been negatively affected. This is important because if a person is ‘labelled’ as being ill this could have a negative affect on the person and also make them feel that their own experience and views have been disregarded. It is also important to recognise that this will vary between individuals, communities and cultures.
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Activity 3.9
Read the article Schickler, P. (2005) Achieving health or achieving wellbeing? Learning in Health and Social Care 4(4), pp. 217–227.
Ask yourself the questions that the participants were asked about health and wellbeing; what does this tell you about how you view your own health and wellbeing?
This is relevant in relation to maternity care; midwives need to emphasise to women that pregnancy is not an illness and that the whole process of childbirth is one of normality. There has been an ongoing debate for many years about the medicalisation of childbirth and its impact on women and their babies. The view is that by putting women in hospitals to give birth and focusing on risk rather than normality, as well as the involvement of doctors, has meant that rather than see childbirth as a normal health event, Western society has seen it as one of risk and ill health (Scamell 2011; Barry and Yuill 2012). This has led to a loss of confidence in a woman’s ability to give birth naturally, and to an increase in unnecessary intervention. The language that doctors and midwives use to describe pregnancy and childbirth events also has a psychological impact on the woman and her family; terms such as ‘failure to progress’, ‘failed induction’, ‘lack of progress’, all give an impression of the body as a machine which is malfunction-ing (Walker 2012). Women may feel that this is their fault and that they somehow have control over this process. This can be related to the work of Illich (2012) who saw medicine as a ‘threat to health’; he describes how professionals ‘assert secret knowledge about human nature, knowl-edge which only they have the right to dispense’ (Illich 1977, p. 19). Irving Zola (1977, p. 41) also describes how ‘medicine is becoming a major institution of social control’. He argued that the label of health and illness ‘medicalises living’.
With reference to childbearing, it is possible to see how the impact of reproductive technolo-gies has led to the view that everyone has the right to have a child, and that there is the tech-nology available to achieve this. Prior to this development women and men were accepting of the fact that difficulties with their fertility meant they would not be able to have a biological child, even though this would be met with sadness and psychological distress. Unfortunately in reality these advances will not lead to all couples having a baby, whether it is biologically related or not. There are also the financial implications of these technologies at a time of auster-ity, leading to inequalities of access to treatment dependent on post codes and wealth.
During the process of undertaking these technologies such as in vitro fertilisation (IVF) there can be a loss of health and wellbeing due to the physical and psychological impact of these treatments. This can be similar to how pregnant women feel about the process of childbirth and the many recorded physical and psychological side effects. For example; some disorders of pregnancy are labelled ‘minor’. However, if a person who was not pregnant woke up every morning feeling nauseous and vomiting, and it continued throughout the day, one can be sure that they would not feel that this was a ‘minor’ illness. This identifies how all health and wellbe-ing needs to be viewed in context; for example, a person with multiple sclerosis may feel that they have a good level of wellbeing, but anyone else with the same symptoms would feel that they were unwell.
The implications and response to the pain of labour is an interesting factor in relation to health, illness and wellbeing. Pain is normally a physiological response of the body to a patho-logical process. The purpose of pain is normally to identify some problem with the functioning of the body. A normal social response to pain is to view it in a negative way, to see it as a warning
55 that something is wrong and to want to find out what it is and to find ways to manage and cope with the pain.
There has been a great deal written about the ‘sick role’ (Giddens 2009; Mik-Meyer and Obling 2012) and how this impacts on a person’s experience of illness and what society would see as their obligation to take action to get well. The link to pregnancy can be problematic as this is not seen as an illness, rather an identification of health, although it can be seen that some women do take on the sick role in order to manage their symptoms and in response to the views of their family and community. Midwives can encourage women to eat healthily and exercise normally, promoting good health for woman and baby, but some women feel that they need to ‘eat for two’ and that exercising is somehow dangerous for them and the pregnancy.
This would appear to be further emphasised by the media with stories around what pregnant women should and should not do. It can be seen that pregnant women and mothers have responsibilities shaped by their community, which they are obliged to engage with in order to be seen as ‘good mothers’, with negative consequences if they falter outside of the expected cultural norms (Armstrong and Eborall 2012).
Activity 3.10
What does this story say about acceptable behaviour of women; what about their partners?
Have a look at the NICE guidelines and see how accurate this story is.
[Available online] http://www.telegraph.co.uk/health/healthnews/10052282/Smoking-test-for -mothers.html
Activity 3.11
Go to the link below and think what message that this story gives to pregnant women about acceptable behaviour.
http://www.thesun.co.uk/sol/homepage/woman/4846871/I-ate-for-two-and-put-on-8-stone .html
Key points
•
The society in which we live has a significant impact on our lives.•
Society’s views and social norms can label people as being deviant.•
Midwives have a role to play in protecting vulnerable people within society.•
It is essential that midwives put aside their own views and beliefs in order to be caring and compassionate.One of the messages that Western society gives is that members have a responsibility to their community to keep well and their activities should reflect this. This can be linked to what are seen as inappropriate behaviours; for example, messages around obesity, smoking and drug misuse (McDaniel 2013). Antenatal screening could also be seen as part of this message; there are increasing numbers of conditions that can be screened for and it can be viewed negatively if women and their partners do not want to have this screening, or once identified as at risk do not want to have diagnostic tests or treatment (Armstrong and Eborall 2012). The message around breastfeeding can be seen as confusing, the information from healthcare professionals is clear that breastfeeding is good, with clear health benefits for the mother and baby. However, the message from society is often around the need to breastfeed away from the public eye.
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Conclusion
Some key sociological theories and how they can be applied to childbearing and maternity services have been explored and linked to appropriate issues. Sociology has been identified as a key area of knowledge which is required by student midwives and healthcare practitioners (NMC 2009). The circumstances in which people live and into which they are born have a sig-nificant impact on their lives, hopes and aspirations. There has been a discussion on how society views specific groups and behaviours and how this can lead to stigma and discrimination which in turn links to ill health and reduced life chances. There are many elements within a society which can impact on a person’s health; this chapter has identified and explored some of these issues and how they can affect the woman and her family. The family has been identified as a key structure within everyone’s life which can have negative and positive implications. Historical changes in family structures have been examined and how these have impacted on reproduc-tion and the lives of family members. The activities within the chapter should have helped you to examine your own views and experiences within society to help gain a better understanding of how these can impact on women and their families.
End of chapter activities
Crossword
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9 10 11
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Find out more
Below is a list of things you can find out about to enhance your knowledge of the issues and topics covered in this chapter. Make notes using the chapter content, the references and further reading identified, local policies and guidelines and discussions with colleagues.
1. Find out how you would report any safeguarding concerns you had about a member of a family you were caring for.
Who would you go to for support?
2. Look at the census information [available online] http://www.ons.gov.uk/ons/guidemethod/census/2011/index.html paying particular attention to health inequalities and lifestyle and behaviours. If you compare the life expectancy measures for Cornwall and Glasgow City you can see significant differences. Why do you think this is? Have a look at your area and compare that to an area with a lower or higher rate.
3. Think about the following questions:
What is the role of a woman; does this change when she becomes pregnant and then a mother?
What is the role of a man; does this change when he becomes a father?
If pregnancy is not an illness, how can midwives explain all the treatments, appointments and screening which are expected?
What events and experiences have formed your identity? What impact have these had on your life?
Do you believe that infertility is an illness? Is it the right of all couples to have a baby regardless of cost?
4. Draw a family structure diagram and think about how this has changed over the generations.
5. Read the article: Oliver, M. (2013) The social model of disability: thirty years on. Disability & Society 28(7), pp.
1024–1026. Do you agree with his views regarding the welfare reforms?
6. In order for society to be protected against infectious diseases then a certain number of people need to be vaccinated or immunised against the disease. Read the article below and think about how parents who do not participate in these programmes are viewed by the rest of society.
Griffith, H. (2013) Wales measles: 1200 MMR jabs given at drop in clinics. http://www.bbc.co.uk/news/
uk-wales-22048635
Across
1. A society in which men are the most pow-erful and influential
3. A social group which share certain finan-cial, cultural or social characteristics 5. A group of people related by common
descent or heredity 6. Key institution of society
7. The view that one person is inferior to another due to a particular characteristic
8. Treating a person less favourably than another due to a particular characteristic 9. Rules and beliefs which members of any
society are expected to adhere to
12. Shared characteristics which can be geo-graphical including cultural traditions and languages
13. A socially constructed identity
Down
2. Circumstances which mean that a person does not have the means for survival 4. Everyday activities in which family members
communicate with each other and to those around them that they are a family
10. A lived experience
11. A group of people connected together by a shared culture
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Glossary of terms
Class A social group which share certain financial, cultural or social characteristics.
Culture A lived experience within a specific group.
Disability A physical or mental impairment; the impairment has a substantial and long-term adverse effect on their ability to perform normal day-to-day activities.
Domestic abuse Any incident or pattern of incidents of controlling, coercive, threatening behav-iour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality.
Ethnicity A multifaceted quality that refers to the group to which people belong, and/or are perceived to belong, as a result of certain shared characteristics, including geographical and ances-tral origins, but particularly cultural traditions and languages.
Family Form of social grouping.
Family displays Everyday activities in which family members communicate to each other and to those around them that they are family.
Feminism View that women should have equal rights to men and that everyone is equal.
Gender A socially constructed identity which is based around a person’s biological sex.
Patriarchy Society in which men are the most powerful and influential.
Race A group of people related by common descent or heredity.
Sexual orientation General attraction a person feels towards one sex or the other (or both).
Sexuality Sexual characteristics, meanings and social practices.
Social construction Social reality is the product of interactions between individuals and groups.
Social norms Rules and beliefs which members of any society are expected to adhere to.
Society A group of people connected together by a shared culture.
Sociology Scientific study of human life, social groups, whole societies and the human world.
Transgender People who live part or all of their lives in their preferred gender role.
References
Armstrong, N., Eborall, H. (2012) The sociology of medical screening: past present and future. Sociology of Health and Illness 34 (2), pp. 161–176.
Aspinall, P. (2010) Concepts, terminology and classifications for the ‘mixed’ ethnic or racial group in the United Kingdom. Journal of Epidemiology and Community Health 64, pp. 557–560.
Bainbridge, J. (2008) Modern man battles to be included. British Journal of Midwifery 16 (5), p. 319.
Barry, A., Yuill, C. (2012) Understanding the Sociology of Health. London: Sage Publications.
Barnes, C., Mercer, G. (2010) Exploring Disability: A Sociological Introduction. Cambridge: Polity.
Barnes, C., Mercer, G., Shakespeare, T. (2010) The Social Model of Disability. In: Giddens, A. Sutton, P. (eds) (2010) Sociology: Introductory Readings, 3rd edn. Cambridge: Polity, pp. 161–167.
Bickerby, T. (2012) About a boy. The Times 18 June 2012, p. 7.
Bickerby, T. (2012) The letter I wish I’d read. The Times 16 July 2012, pp. 7–9.
Bhopal, R. (2004) Glossary of terms relating to ethnicity and race: for reflection and debate. Journal of Epidemiology and Community Health 58, pp. 441–445.
Brandon, T., Pritchard, G. (2011) Being fat: a conceptual analysis using three models of disability. Disability
& Society 26 (1), pp. 79–92.
59
Braye, S., Dixon, K., Gibbons, T. (2012) A mockery of equality: an exploratory investigation into disabled activists views of the Paralympic Games. Disability & Society Published online 21 December 2012, http://dx.doi.org/10.1080/09687599.2012.748648
Burnett, J. (2013) Britain: racial violence and the politics of hate. Race & Class 54 (5), pp. 5–21.
Burchardt, T. (2010) Capabilities and disability: the capabilities framework and the social model of disability.
Disability & Society 19 (7), pp. 735–751.
Casey, L. (2012) Listening to Troubled Families. London: Department for Communities and Local Government.
Daniel, L. (2005) Children need fathers too: Helping fathers to get involved. British Journal of Midwifery 13 (12), p. 759.
Davies, H. (2011) Sharing surnames: children, family and kinship. Sociology 45 (4), pp. 554–569.
Dahl, B., Fylkesnes, A., Sorlie, V., Malterud, K. (2013) Lesbian women’s experiences with healthcare providers in the birthing context: A meta-ethnography. Midwifery 29, pp. 674–681.
Department of Communities and Local Government (2012) The Troubled Families Programme DCLG. https://
www.gov.uk/government/uploads/system/uploads/attachment_data/file/11469/2117840.pdf Department of Communities and Local Government (2013) The Fiscal Case for Working with Troubled
Fami-lies DCLG https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/79377/
20130208_The_Fiscal_Case_for_Working_with_Troubled_Families.pdf Department of Health (2007) Maternity Matters. London: DH.
Department of Health (2009) Sexual Orientation a practical guide for the NHS. London: DH.
Equality Challenge Unit (2010) Trans Staff and Students in Higher Education. London: ECU.
Equality Act (2010) access online http://www.legislation.gov.uk/ukpga/2010/15/section/6
Farrell, B., VandeVusse, A., Ocobock, A. (2012) Family change and the state of family sociology. Current Sociology 60 (3), pp. 283–301.
Giddens, A. (2009) Sociology. Cambridge: Polity.
Hansom, J., Nur Young, N. (2010) Who cares about teenage dads? Role of a young fathers’ worker. British Journal of Midwifery 18 (2), pp. 106–109.
Harpur, P. (2012) From disability to ability: changing the phrasing of the debate. Disability & Society 27 (3), pp. 325–337.
Hepburn, S., Simon, R. (2006) Women’s roles and statuses the World over. Gender Studies Spring 2006, pp.
62–68.
Home Office (2013) Domestic Violence and Abuse. https://www.gov.uk/domestic-violence-and-abuse Howard, M., Laxton, C., Musoke, P. (2013) Women’s Aid Annual Survey 2013. Bristol: Women’s Aid Federation
of England.
Hughes, B. (2009) Wounded/monstrous/abject: a critique of the disabled body in the sociological imagi-nary. Disability & Society 24 (4), pp. 399–410.
Illich, I. (2012) Ivan Illich on medical nemesis. Nurse Education Today 32, pp. 5–6.
Illich, I. (1977) Disabling professions. In: Illich, I., Zola, I., McKnight, J., Caplan, J., Shaiken, H. (eds) Disabling Professions. London: Marion Boyars, pp. 11–39.
Jackson, K. (2003) Midwifery care and the lesbian client. British Journal of Midwifery 11 (7), pp. 434–437.
James, A., Curtis, P. (2010) Family displays and personal lives. Sociology 44 (6), pp. 1163–1180.
Joseph Rowntree Foundation (2013) Poverty, Participation and choice http://www.jrf.org.uk/publications/
poverty-participation-and-choice
Joseph Rowntree Foundation (2011) Monitoring poverty and social exclusion 2011. York: JRF.
Kane, E. (2012) Rethinking Gender and Sexuality in Childhood. London: Bloomsbury.
Larkin, M. (2009) Vulnerable Groups in Health and Social Care. London: Sage Publications.
Lee, E. (2004) Lesbian users of maternity services: appropriate care. British Journal of Midwifery 12 (6), pp.
353–358.
Levitas, R. (2012) There may be trouble ahead: What we know about those 120,000 ‘troubled’ families Poverty and Social Exclusion in the UK http://www.poverty.ac.uk/system/files/attachments/WP%20Policy%20 Response%20No.3-%20%20%27Trouble%27%20ahead%20%28Levitas%20Final%20 21April2012%29.pdf
ManKind Initiative (2013) Types of domestic abuse [online] Available: http://www.mankind.org.uk/
typesdomesticabuse.html
Marchbank, J., Letherby, G. (2007) Introduction to Gender: Social Science Perspectives. London: Pearson Education.
McDaniel, S. (2013) Understanding health sociologically. Current Sociology 61 (5–6), pp. 826–841.
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McKie, L., Callan, S. (2012) Understanding Families A Global Introduction. London: Sage.
Mik-Meyer, N., Obling, A. (2012) The negotiation of the sick role: General Practitioners’ classification of patients with medically unexplained symptoms. Sociology of Health and Illness 347, pp. 1025–1038.
Nursing and Midwifery Council (2009) Standards for pre-registration midwifery education. London: NMC.
Oliver, M. (1996) Understanding Disability: From Theory to Practice. Basingstoke: MacMillan.
Pierson, J. (2010) Tackling Social Exclusion. London: Routledge.
Price, C. (2012) Fatherhood and maternity care. British Journal of Midwifery 20 (12), p. 910.
Poverty and Social Exclusion (PSE) (2013) Absolute and overall poverty http://www.poverty.ac.uk/
definitions-poverty/absolute-and-overall-poverty Accessed 10th July 2013.
Powell, J., Uppal, E. (2012) Safeguarding Babies and Young Children. Maidenhead: Open University Press.
Royal College of Midwives (2011) Reaching out: Involving fathers in maternity care http://www.rcm.org.uk/
college/policy-practice/government-policy/fathers-guide/
Schickler, P. (2005) Achieving health or achieving wellbeing? Learning in Health and Social Care 4 (4), pp.
217–227.
Sparrow, R. (2010) Implants and ethnocide: learning from the cochlear implant controversy. Disability &
Society 25 (4), pp. 455–466.
Swain, J., French, S. (2000) Towards an affirmation model of disability. Disability & Society 15 (4), pp.
569–582.
Tomlinson, M., Kelly, G. (2013) Is everybody happy? The politics and measurement of national wellbeing.
Policy & Politics 41 (2), pp. 139–157.
Townend, P. (1979) Poverty in the United Kingdom. http://www.poverty.ac.uk/definitions-poverty/
absolute-and-overall-poverty
Walker, S. (2012) Mechanistic and Natural body metaphors and their effects on attitudes to hormonal contraception. Women & Health 52 (8), pp. 788–803.
Walsh-Gallagher, D., Sinclaire, M., McConkey, R. (2012) The ambiguity of disabled women’s experiences of pregnancy, childbirth and motherhood: A phenomenological understanding. Midwifery 28, pp.
156–162.
Williams, C., Alderson, P., Farsides, B. (2002) What constitutes ‘balanced information in the practitioners’
portrayals of Down’s Syndrome? Midwifery 18, pp. 230–237.
Witham, G. (2012) Child Poverty in 2012 It Shouldn’t Happen Here. Manchester: Save The Children.
World Health Organization (2013) Female Genital Mutilation http://www.who.int/mediacentre/factsheets/
fs241/en/
Zola, I. (1977) Healthism and disabling medicalization. In Illich, I., Zola, I., McKnight, J., Caplan, J. (eds), Disa-bling Professions. London: Marion Boyars.
Chapter 4
Psychology applied to maternity care
Julie Jomeen Lynda Bateman
University of Hull, Hull, UK University of Hull, Hull, UK
By the end of this chapter the reader will be able to:
•
identify the main theoretical models of psychology•
discuss why the study of psychology helps to understand behaviour or individual responses to a given situation•
recognise how psychology can help midwives relate to the women in their care and their families•
recognise that midwifery practice can be enhanced by understanding psychology.Learning outcomes
Introduction
Psychological health is important with respect to how we function and adapt. Its relevance to childbearing women is clear when we acknowledge the significant transition and adaptation that women go through in their journey from conception through to motherhood. Understand-ing psychology in relation to pregnancy, birth and the postnatal period will afford midwives insight into the complexity of a woman’s experience and enable a more perceptive considera-tion of her emoconsidera-tional needs. Midwives are key to assuring the quality of women’s experiences across the perinatal period and hence can be central to women’s emotional health and wellbe-ing. How they communicate and interact with women can have both momentous and enduring consequence. This chapter will explore the study of how psychology can help midwives relate to the women in their care and their families.
Fundamentals of Midwifery: A Textbook for Students, First Edition. Edited by Louise Lewis.
© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd.
Companion website: www.wileyfundamentalseries.com/midwifery
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