Fundamentals of Midwifery: A Textbook for Students (26 page)

Activity 3.8 Read Tom Bickerby’s articles: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.Reflect on how you feel about the information in the articles.
Health and wellbeing
There are many different definitions of health, which vary from the lack of disease, to the abilityto 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.
Activity 3.9 Read the article Schickler, P. (2005) Achieving health or achieving wellbeing
? Learning in Health
and Social Care
4(4), pp. 217–227.54 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 warningthat 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 astheir obligation to take action to get well. The link to pregnancy can be problematic as this is
⁵⁵
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.htmlOne 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.
Activity 3.11 Go to the link below and think what message that this story gives to pregnant women aboutacceptable behaviour.http://www.thesun.co.uk/sol/homepage/woman/4846871/I-ate-for-two-and-put-on-8-stone.html