Self-care, midwifery and medicine : women's perspectives on negotiating a healthy reproductive experience




Westfall, Rachel Emma

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This thesis presents the results of a qualitative study of self-care in pregnancy, birth and lactation within a non-random sample of 27 women in British Columbia, Canada. The women were interviewed in the third trimester of pregnancy, and 23 of the participants were re-interviewed post-partum. Interviews were tape recorded, transcribed, and subjected to thematic analysis. Results were discussed in the context of the social science literature on the medicalization of pregnancy and childbirth. All but one woman used herbal medicine while pregnant. In the post-partum interviews, nearly half reported using galactagogue herbs. The safety and efficacy of each herbal remedy are discussed here. Most of the herbs are considered safe and effective according to the herbal literature, but clinical reports are largely lacking. While many of the women were cautious about using herbs during pregnancy, as a general rule, they considered them to be safer than pharmaceutical drugs. In choosing to self-medicate with herbs, the women said they were guided by prior knowledge (32%), trusted sources of advice (56%), and intuition (12%). Trusted sources of advice included books, friends, family members, maternity care providers, herbalists, herbal shops, and internet. The majority of herbal advice (69%) was received by word-of-mouth. Prolonged pregnancy also proved to be an interesting situation. Many women said they were opposed to labour induction at the time of the first interview, yet all but one woman who went beyond 40 weeks gestation used self-help measures to stimulate labour. This appeared to be a response to pressure from maternity care providers, friends, and family members. Though the medical definition of prolonged pregnancy is 42+ weeks gestation, in the social context, 40+ weeks was cause for concern. Health care professionals, partners, family members, friends, and co-workers all affected self-care behaviour, and their influence could be positive or negative. After an overwhelmingly negative experience with a maternity care provider, over half of the women went to another care provider, or forewent formal maternity care entirely. These findings did not support the hypothesis that childbearing is almost completely medicalized, at least for the sample population. Rather, women negotiated their maternity care within several frameworks, including the medical, midwifery, and self-care models. Medical language was used to describe birth stories, but only by women in physician care. There was an almost universal effort among the women to normalize the childbearing experience. The findings of this study point to a need for: (1) clinical investigation of herbal medicines used in pregnancy, birth and lactation; (2) public and care-provider education regarding social and psychological aspects of prolonged pregnancy; (3) broad-scale inquiry into the phenomena of medicalization/normalization of the childbearing experience, and (4) further investigation into women’s preferences for empowering styles of maternity care.



Prenatal care, Pregnancy, Herbs