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CHILDBIRTH THROUGH CHILDREN'S EYES

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Authors Anderson, Sandra VanDam, 1943-

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University Microfilms International 300 N. Zeeb Road Ann Arbor, Ml 48106

8322636

Anderson, Sandra Vandam

CHILDBIRTH THROUGH CHILDREN'S EYES

The University of Arizona PH.D. 1983

University Microfilms International 300 N. Zeeb Road, Ann Arbor, Ml 48106

CHILDBIRTH THROUGH CHILDREN'S EYES

Sandra VanDam Anderson

A Dissertation Submitted to the Faculty of the

COLLEGE OF NURSING

In Partial Fulfillment of the Requirements For the Degree of

DOCTOR OF PHILOSOPHY

In the Graduate College

THE UNIVERSITY OF ARIZONA

19 8 3

As members of the Final Examination Committee, we certify that we have read the dissertation prepared by Sandra VanDam Anderson entitled Childbirth Through Children's Eyes

and recommend that it be accepted as fulfilling the dissertation requirement for the Degree of Doctor of Philosophy .

MjUcl a AAix t fo-y i? Wv / / V (] Date ^

^ /3 Qts-j-e /

Date"" '

Date

Final approval and acceptance of this dissertation is contingent upon the candidate's submission of the final copy of the dissertation to the Graduate College.

I hereby certify that I have read this dissertation prepared under my direction and recommend that it be accepted as fulfilling the dissertation requirement.

^ C?), /o /?f

This dissertation has been submitted in partial fulfillment of requirements for an advanced degree at The University of Arizona and is deposited in the University Library to be made available to borrow ers under rules of the Library.

Brief quotations from this dissertation are allowable without special permission, provided that accurate acknowledgment of source is made. Requests for permission for extended quotation from or repro duction of this manuscript in whole or in part may be granted by the copyright holder.

SIGNED: ACKNOWLEDGMENTS

The successful completion of this dissertation has not been

accomplished alone. I am particularly grateful to the members of my major committee. I acknowledge Dr. Eleanor Bauwens for her unstinting help during the entire period of doctoral study. Her insight, kind ness and understanding were generously offered and very sincerely appreciated. Her practical and wise advice from the beginning idea

to pursue a degree to the last theme delineated in the dissertation has kept me "on track." To Dr. Margarita Kay I am grateful for initial encouragement to systematically study topics of abiding interest to me, and for just the right amount of direction to stimulate my curiosity and guide my fledgling efforts. Her guidance has continued

throughout the course of study, and has been especially helpful during

the cross-cultural review of literature and the collection of data. I acknowledge the assistance of Dr. Agnes Aamodt, especially during the final analysis and presentation of data.

Special thanks are due the children who shared with me their recent experiences of witnessing childbirth, and the parents who allowed the children to discuss an intimate family event with me.

I am appreciative to Charlene Wagonlander for her good judge ment, cheerfulness and efficiency displayed in the hours of service to prepare this manuscript.

iii My deepest gratitude is felt toward my family—my children,

Josiah and Jana, and my parents, Ed and Marian VanDam, and also

toward my friends, Lydia Breen, Janice Burke, John Fife, John Gaines,

Jeanne Jensen, Robin Perin, Melinda Staveley, Jeanne Taylor,

Benny Wanjala, Diana and Winston Warr and many others. Thank you

for your love, patience, diversion and most of all for believing

and assuming that I could accomplish my goals. TABLE OF CONTENTS

Page

LIST OF ILLUSTRATIONS viii

LIST OF TABLES x

ABSTRACT . . xi

1. INTRODUCTION: CHANGING BIRTHING PATTERNS 1

Current Attitudes toward Childbearing 2 Medicalization of Birth 3 Reaction of Alternative Birth Movement...... 5 Reaction of Professional Organizations 8 Study Proposal 10

2. BACKGROUND OF THE STUDY: CHILDREN AND CHILDBIRTH 12

Significance of the Study 12 Children's Concepts of Sexuality and Birth 15 Birth in the Family: Becoming a Sibling 21 Sibling Presence at Birth 23

3. ACCESSIBILITY OF CHILDBIRTH TO CHILDREN: CROSS-CULTURAL COMPARISON 33

Sociocultural Influences on Birth Practices 34 Cultural Differences Through Space and Time 37 Human Relations Area Files Survey 37 Attitudes toward Children at Birth as Depicted in Games and Art 66 Historical Documentation 73 Summary 75

4. THE GUIDING PERSPECTIVES 77

Childbirth as a Sociocultural Event 77 Culture of Childhood 81 Child's-Eye View 83 Cognitive Development 87

v vi

TABLE OF CONTENTS—Continued

Page

5. METHODOLOGY: THE ETHNOGRAPHIC APPROACH 93

The Researcher 94 The Informants 98 Children as Informants 98 Study Informants 106 The Research Design 112 Qualitative Research 112 Ethnographic Data and Analysis 116 The Setting 119 Getting In 120 Data Collection and Analysis 122

6. PRESENTATION AND ANALYSIS OF DATA 129

Characteristics of the Sample 129 The Informants 130 Families of the Informants 131 Birth Events Witnessed by the Informants 133 Domains of Meaning in the Child's View of Childbirth. . . . 137 People Who Do Things at Birth 137 Steps in a Baby Being Born 141 Things People Do at Birth 151 Best Parts of Being There 164 Worst Parts of Being There 167 Things that are Gross at Birth 171 Things that are Scary at Birth 177 Things for Kids to Know about Being There 190 Themes 200 I Never Seen It Before 200 The First Time You Don't Know 202 It Might Not be Scary for You, but It Was For Me. . . . 203 The More Often You See It, the Less It Bothers You. . . 204 Dads, Kids and Ladies Help 205 I Can't Stand to Miss It 205 It's Kind of Gross for the Person Who has to Watch. . . 206 You Learn by Being There 206 Summary 207

7. CONCLUSIONS AND RECOMMENDATIONS 209

Themes and the Research Questions 209 Themes and the Background of the Study 211 Themes and the Guiding Perspectives 218 vii

TABLE OF CONTENTS—Continued

Page

Themes and Health Care 221 Recommendations for Future Study 228 Conclusion 232

APPENDIX A: ACCESSIBILITY OF CHILDBIRTH TO CHILDREN IN 50 CULTURAL UNITS WITH OUTLINE OF WORLD CULTURES (OWC) CODE 234

APPENDIX B: PARENTAL CONSENT FORM. ... 239

APPENDIX C: CHILD CONSENT FORM 242

APPENDIX D: SELF-REPORTED DEMOGRAPHIC PROFILE OF 14 INFORMANTS AND THEIR FAMILIES WITH PSEUDONYMS 244

APPENDIX E: INFORMANTS' DRAWINGS 248

APPENDIX F: DIMENSIONS OF CONTRAST IN THINGS THAT HAPPEN DURING THREE STAGES OF BIRTH 261

REFERENCES 266 LIST OF ILLUSTRATIONS

Figure Page

1. A demon watches the labor of a Balinese woman who is supported by a man and a child 67

2. Demon lies in wait for the emerging newborn 68

3. Family visiting a Chinese lying-in woman, while the midwife holds the child in her arms 70

4. German lying-in room of the sixteenth century 71

5. Children visiting the mother and infant in Holland 72

6. The lying-in woman receives visitors 72

7. Domains of meaning in people who do things at birth 138

8. Domains of meaning in things moms do at birth 153

9. Domains of meaning in things dads do at birth 156

10. Domains of meaning in things kids do at birth 158

11. Domains of meaning in things midwives do at birth 162

12. Domains of meaning in things babies do at birth 163

13. Domains of meaning in best parts of being there 165

14. Domains of meaning in worst parts of being there 168

15. Domains of meaning in things that are gross at birth .... 173

16. Domains of meaning in things that are scary at birth .... 178

17. Domains of meaning in scary things in life .... 184

18. Domains of meaning in things for kids to know about being there 192

viii ix

LIST OF ILLUSTRATIONS—Continued

Figure Page

E-1. Mom on the birth chair 250

E-2. Mom feeling happy 251

E-3. Dad comforting mom 252

E-4. Trying to pull it out 253

E-5. And the baby is born 254

E-6. Waiting for the baby to come 255

E-7. We all helped 256

E-8. The head is coming out 257

E-9. Holding the baby 258

E-10. Mommy having the baby 259

E-ll. Blood is coming out 260 LIST OF TABLES

Table Page

1. Major world areas,cultural units, and accessibility of childbirth to children 40

2. World regions and accessibility of childbirth to children in the Murdock Sample of 150 cultural units 65

3. Three dimensions of contrast in domains of meaning in steps in a baby being born 143

x ABSTRACT

The purpose of this study is to describe six-to twelve-year-old children's views of childbirth using words and drawings of children who were present when a baby was born in order to understand chil dren's conceptualization of birth. As background to the study, the accessibility of childbirth to children through time and space was reviewed in the Human Relations Area Files. The information revealed cultural units both allowing and forbidding attendance of children at birth.

Interviews and drawings were used to collect data from 14 informants. Audiotape-recordings of the interviews were transcribed, analyzed and organized into meaningful categories, which were validated by six key informants. The categories represented the knowledge used by children to interpret childbirth and included: people who do things at birth, steps in a baby being born, things people do at birth, best parts of being there, worst parts of being there, things that are gross at birth, things that are scary at birth, and things for kids to know about being there.

The relationships of the categories were discussed in themes inferred from the data by the researcher. The themes identified were:

I never seen it before; the first time you don't know; it might not be scary for you, but it was for me; the more often you see it, the

xi xii less it bothers you; dads, kids and ladies help; I can't stand to miss it; it's kind of gross for the person who has to watch; and you learn by being there.

The themes are discussed in relation to the research questions, health care and concepts that guided the study (childbirth as a sociocultural event, culture of childhood, child's-eye view, and cog nitive development). Health professionals, especially nurses, have the opportunity to prepare parents and children for birth, to facilitate family-centered birthing practices and to minimize the strains related to life processes, such as birth and development. Childbirth through children's eyes communicates the birth event as a situational crisis as well as a developmental opportunity. CHAPTER 1

INTRODUCTION: CHANGING BIRTH PATTERNS

Most healtH professionals considered it revolutionary when Lang

(1972, p. 1) dedicated the Birth Book "to all children who will never ask 'Where do babies come from?'" Children's participation in child birth was a new idea introduced in the United States in the 1970s.

Participation by children in the birth event has continued to be a contro versial topic, receiving attention from both parents and professionals interested in family-centered care during childbearing events, as well as from anthropologists, child psychologists, and sociologists interested in the sociocultural patterning of childbirth.

Birth, as a prototypical life crisis event, is a point of con vergence for many disciplines. Birth "allows a focusing on one of the dramatic limits of humanity—that which defines life (Newman 1972, p.51)." Anecdotal evidence regarding the benefits and/or trauma to children observing birth abounds, but scientific data concerning these subjects are scarce.

The purpose of the present research is to describe the child's- eye view of childbirth using children's words and drawings in order to understand children's conceptualization of birth. It is a premise of the study that children do not share the adult view of birth.

Children have their own understanding and perspective of the world and

1 2

their experiences. This study provides information concerning the

child's view of birth that can: (1) assist parents, children and health

professionals to make decisions about the preparation and participation

of children for the childbirth event; (2) generate nursing knowledge

which supports the applied science of nursing specifically in the care

of children and childbearing parents; and (3) contribute to the

ethnographic literature by describing the child's view of a major

life-cycle event in contemporary American culture.

Current Attitudes toward Childbearing

The practice of including children at birth must be understood within the context of the alternative childbirth movement in the

United States, as well as within the larger sociocultural perspective of birth practices around the world. During the past 15 years numerous events, such as the proliferation of technological intervention and consumer demands for family-centered obstetrical care, have influenced

the way maternity care is provided in the United. States.

Two discordant themes dominate current attitudes toward childbearing (Anderson and Simkin 1981). One theme is that child

birth is always potentially hazardous, and that a diagnosis

of "normal" can only be made after the birth. Birth is considered

to be mysterious and dangerous, and thus must be controlled by

specialists ready to intervene with the latest technological

devices. There is consensus that birth is messy, if not dirty.

Childbirth is cloaked in privacy. In the last few years 3 fathers have been "allowed" to be present. Nevertheless, birth is still considered most appropriate for the eyes and ears of medical personnel (Mead and Newton 1967).

The second prevailing theme holds that most birth is normal and best conducted by relying on the woman's own physiological mecha nisms and on psychological support from caring family members and knowledgeable practitioners, preferably midwives. Adherents to this position believe births proceed best when care is based on the princi ple of "watchful expectancy." Knowledge about the birthing process and active participation by the parents-to-be are considered important.

Along with knowledge, many parents seek some control over the birthing event, such as where the birth occurs and who is present at the birth. As parents have gained more control over childbirth, they have exerted their wishes, which at times include the presence of sib lings at the birth itself. These parents, usually oriented toward childbirth with minimal intervention and maximal support, discard the idea that childbirth is something to be shrouded in mystery and modes ty. Rather, they consider birth, whether at home or in the hospital, as important to the entire family, including children. Birth is seen as a rare and special event in the family life cycle, an event to be openly celebrated with family members. Because each birth is also the birth of a new family unit, some people believe childbirth is an expe rience belonging to the entire family.

Medicalization of Birth

In Western culture, most childbearing women gave birth in a family setting until the 1940s, when the hospital replaced the home as 4 the accepted site for birth. Before the shift to the hospital, it was unlikely that children were permitted to observe home births

(Barker-Benfield 1976). Although there has been little documentation of the role of children at early home births, oral history has suggested' that births were hidden to some extent from children and men, even though they were waiting nearby.

As more and more women went to hospitals, emphasis shifted from birth as a family event to birth as a medical procedure. The hospitalization of birthing women has resulted in dehumanization similar to that which accompanied the hospitalization of dying individuals

(Kubler-Ross 1976). Within Western culture many parallels exist in social attitudes toward the major life events of birth and death. Both events tend to be mysterious, produce fear, and are generally very separate from daily living. Adults assume children have the same anxiety-ridden perspec tive, and, therefore, need to be protected from exposure to birth and death. Both events are usually shared and controlled by strangers, and frequently occur in unfamiliar territory.

The sociocultural influence on how people perceive and manage birth and death is apparent in the contrast of Western culture with the

Zulu of South Africa. Kitzinger (1980, p. 27) briefly describes the participation of Zulu children at birth qnd death: "Children are brought into birth as they are brought into a death, because it is im portant to them that children learn to respect birthing and dying.

This is bringing them into touch with reality. This is an important experience for them." Kitzinger (1980) questions whether Western 5

culture, through the medicalization of childbirth, has drained the

birthing event of philosophical meaning, and turned birth and death

into purely technical physiological processes.

Reaction of Alternative Birth Movement

During the 1970s various authors discussed the dehumanization

of birth (Arms 1975, Sousa 1976, Ward and Ward 1976). Individuals and

groups began reclaiming the significant life-cycle events of birth

and death for families (Anderson and Simkin 1981). Hazell (1974) be

lieved the alternative birth movement was, in part, a response to the

dehumanization of birth, as well as a desire by parents to include

their children in the birth process.

Increasing numbers of couples have chosen to give birth at home

or in maternity centers or hospitals that allow the family to stay to

gether throughout the birth experience. Between the years 1972 and

1975, a period when the total number of births actually declined, the

number of out-of-hospital births in the United States increased by 60

percent (National Center for Health Statistics 1977). The trend toward

home births in the 1970s indicated that some Americans were searching

for alternative forms of maternity health care.

Not only Americans were searching for alternatives. In England

Kitzinger (1978) investigated the birth experiences of 65 English women,

23 primiparae and 42 multiparae. The women gave accounts of 74 hospital births and 55 home births occurring over time. Using an open-ended questionnaire, she found that the four major reasons for wanting a home birth were: (1) objections to routine hospital 6

practices; 2) wanting a natural birth; 3) concern about bonding with

baby; and 4) wanting the birth to be presented as a normal part of

living to other children in the family. Kitzinger (1978) also obtained

information about mothers' preference for the informal atmosphere of

home. Mothers reported how birth within the normal context of family

life allowed the toddler to accept the new baby more easily, saved the

older child from the trauma of maternal absence, and educated the sib

ling in positive values about birth, instead of making children infer

that having a baby was something a woman went to the hospital for in order to be cured.

Anderson, Bauwens, and Warner (1978, p. 44) investigated via interview 69 home births in a metropolitan county in Arizona. They interpreted the choice of home birth as an adaptive mechanism, a way of coping with the environment and with unmet needs: "The adaptive strat egy of choosing a home birth apparently satisfies unmet needs experi enced by some mothers when hospital rules and regulations, medical policies, habits, customs, and rituals are made compulsory for all those seeking obstetrical care in the hospital setting."

Goodell (1980) reported that home births tripled between 1973 and 1978. Health professionals responded by offering "birthing rooms" or "alternative birth centers," which numbered over 1000 by 1979. The

American College of Obstetricians and Gynecologists surveyed 78 alter native birth centers, and found 53 percent (n=41) allowed children in the labor facilities and 44 percent (n=34) permitted children at the births (Goodell 1980). 7

The International Childbirth Education Association (Phillips

1983, p. 8) conducted a more recent survey of 78 family-centered birth facilities in the United States. Family participation was encouraged in all the facilities. "Although 86 percent reported sibling visita tion, only 34 percent reported sibling visitation during labor. At birth, sibling participation dropped to 23 percent. The largest percent of sibling visitation occurred post-partum (86 percent)."

Another survey,- conducted by the Institute of Medicine (IOM), • found that the data on the numbers of alternative-setting births were very inexact, but estimated that in 1980 between 36,000 and 159,000, or one to four percent, of all babies were born outside the hospital. The number of freestanding birth centers grew from 3 in 1975 to 130 in 1982

(The Nation's Health 1983).

As the number of births in places other than conventional hos pital obstetrical units has increased, different consumer and profes sional groups have fervently debated the hazards and benefits of alternative settings offering family-centered care. The IOM Committee concluded that "unfortunately the absence of adequate data on a whole range of issues associated with birth settings makes it unlikely that the controversy will ease in the immediate future or that parents can make informed choices about the setting best for them (The Nation's

Health 1983, p. 6)."

An urgent ongoing question concerns the ability to predict with certainty a low-risk birth. Other questions recommended for study by the IOM Committee include how birth practices differ between and within 8 settings, as well as the psychological benefits of different practices in different settings.

Reaction of Professional Organizations

Professional organizations have reacted to consumer demands for more sensitive care. A family-centered philosophy toward birth has been adopted by the Interprofessional Task Force on Health Care of Wom en and Children. This task force includes individuals from the Ameri can Academy of Pediatrics, the American College of Nurse-Midwives, the

American College of Obstetricians and Gynecologists, the American

Nurses' Association, and the Nurses' Association of the American College of Obstetricians and Gynecologists. The Interprofessional Task Force on Health Care of Women and Children, in a 1978 position statement, has suggested that health care delivery systems should adhere co the follow ing philosophy:

- that the family is the basic unit of society; - that the family is viewed as a whole unit within which each member is an individual enjoying recognition and entitled to consideration; - that childbearing and childrearing are unique and important functions of the family; - that childbearing is an experience that is appropriate and beneficial for the family to share as a unit; - that childbearing is a developmental opportunity and/or a situational crisis, during which the family members benefit from the supporting solidarity of the family unit (Interprofes sional Task Force on Health Care of Women and Children 1978).

In the same year (1978) the International Childbirth Education

Association (ICEA) also developed a position paper supporting the

"presence of family and/or friends during labor, birth, and post-partum as desired by the childbearing woman (ICEA 1978)." Position statements 9 are helpful in terms of general guidelines. However, conflict general ly exists about the operationalization of philosophical statements, and this holds true in regard to the specifics of what, when, where, and how existing children in the family participate at birth.

Individuals who strongly believe that the answers to questions on children's participation at birth can only be found within each family constellation usually view scientific inquiry into the issue of children at birth as a waste of time and money. Their position advo cates a reliance on common sense and anecdotal evidence. These individuals believe families have the right to choose where and how the birth happens, and who is present at the birth.

Health professionals involved with determining institutional guidelines, setting hospital policies, and advising clients about preparation and participation of children at birth find it uncomfort able to rely on anecdotal evidence that does not have a scientific basis. They maintain that impressions and intuition are insufficient substitutes for hard data from clinical studies. For example Taylor

(1981, p. 6) believes:

The question of the advisability of siblings' attend ing deliveries is too important to attempt to settle by rhetoric, speculation or casual observations. It will be difficult to design studies to obtain valid insights into this question, yet the issue is so vital that the efforts must be made. Caregivers who advocate or condone children attending birth should take this responsibility seriously.

Conflict may occur when parents and professionals do not share a simi lar perspective. While families continue to exercise their right to choose, professionals must pursue additional knowledge about the presence of children at childbirth through scientific inquiry. Study Proposal

The present study proposes to add to current knowledge about

the presence of children at childbirth by collecting and analyzing

data from six-to twelve-year-old children regarding their views of

birth. ' Children's point of view of childbirth is currently a topic

of interest due to the contemporary controversial practice in the

United States of including siblings, and occasionally other children,

at the birth scene.

The major questions that are considered in this study include

(1) What is the six-to twelve-year-old child's view of childbirth?

(2) How do children conceptualize birth in contemporary American cul

ture? (3) What factors influence children's participation at child

birth? These questions have been derived in part from the interest

of health professionals in family-centered births, and in part from

the anthropological concept of culture, and the influence of culture

on birthing practices. Sociocultural information about childbirth

is sparse, and rarely includes the child's view. Since childbirth is

a universal event, it lends itself to the study of behavioral and

conceptual variability in children.

The organizing ideas for collecting and ordering the infor

mation follow the ethnographic method, as described by Spradley

(1979). The ethnographic method utilizes the language of infor

mants to elicit their point of view. The researcher attempts to

"get into the shoes" of informants by way of their verbal interpre

tations of their experiences. Through use of the ethnographic method, cultural knowledge related to the children's experiences of being present at childbirth will be elicited from six-to twelve-year- old children.

Insights into the child's view of birth provide an effective basis for preparing a child for the common universal experience of becoming a sibling. "As human beings, we are all responsible for assisting the comings-in and goings-out of our sisters and brothers regardless of our ages, each of us contributing at our own level of participation, whatever that is (Hazell 1981, p. x)." This study describes the view of the six-to twelve-year-old child toward child birth and thereby assists health professionals, parents and others to understand the meaning of childbirth to children. CHAPTER 2

BACKGROUND OF THE STUDY: CHILDREN AND CHILDBIRTH

Gesell once said that our knowledge of the child is about as reliable as a 15th century map of the world (Kellogg and O'Dell

1967). Our knowledge of children's ideas about the fundamental facts of life, such as sexuality, conception and birth are especial ly meager. Montagu (1981, p.5) agrees that we really don't under stand children, and that we underestimate their qualities:

...what the child does have is a great hankering for knowledge, learning, wonder and curiosity as well as oppor tunities to experience everything that he is capable of ab sorbing. Therefore, I certainly think we need to talk more about what is the place of the sibling in the family in special relation to the birth of another sibling, and in re lation to the knowledge of the processes of pregnancy and childbirth.

Significance of the Study

Children's views of childbirth are of interest to health professionals providing family-centered care to the childbearing popu lation in order that they may give counsel to families and facilitate a positive experience for siblings whether or not families choose to include them in the birth event. Children's views of birth are also of interest to health administrators responsible for establishing sound institutional policies, as well as to family theorists, psychologists and anthropologists.

12 13

Family theorists are interested in the impact on sibling rela tionships. Holman and Burr (1980) report that the subject of sibling relationships in general has been overlooked for years, even in the decade of the 1970s, a period of rapid development in family theory.

"It is reasonable to assume that the experiences children share with siblings have a profound influence on their socialization and person ality development processes. It is surprising that so central and fundamental an experience has received so little conceptual, empir ical, and theoretical attention (Schvaneveldt and Ihinger 1979, p. 453)."

Sibling relationships are especially significant throughout childhood (Dunn and Kendrick 1979) as well as throughout the life span.

Sobel (1980) reports a survey of sibling relationships conducted by

Cicirelli which documents the far-reaching effects of childhood sib ling rivalry, and the impact early sibling rivalry may have on adult sibling and family relations. Eighty percent of elderly Americans have at least one living sibling and frequently rely on that person for help or companionship. Often sibling-sibling relationships en dure beyond parent-child relationships and share a history unmatched in spousal relationships. Today's frequent divorces and remarriages may create future families in which the siblings have stronger bonds to each other than to their parents or stepparents.

The significance of the presence of siblings at the birth of a brother or sister in regard to short-or long-term attachment has not been established. Klaus and Kennell (1976) have identified basic

principles in the process of attachment. One of these is that ob

servers of the birth process become strongly attached to the infant.

Lang (1972) has noted that witnesses to labor and birth be

come more attached to the infant than do family and friends who were

not present or who did not participate in the sensitive period

immediately after birth. Walker, Yoffe, and Gray (1979) commented

that when siblings were included the baby became their special pre

sent and they were more accepting of the stranger in their midst.

Rising (1974) stated there is a certain openness about the

"fourth stage of labor" that may never occur again. Therefore, she

advised visitation privileges as being essential for the newborn's sib

lings, if they are healthy. Montagu (1977) wrote that the early bond

established between the father and his child would probably hold true for siblings if they were allowed early contact with the new family

member.

In contrast, Fragner (1979, p. 33) reported that for children,

bonding was a very different experience and served a different purpose

than for adults:

For children, the bonding process which begins to occur at birth is not rooted in biological necessity and serves a vari ety of emotional and social needs for each child. Children can use the sensitive period to begin examining the infant and discovering its unique traits; this exploratory experience serves as a bridge between the children's fantasy and the re ality of the infant in their lives. Cultural anthropologists are interested in children's views of

childbirth as they relate to the culture of childhood, that is, chil

dren's unique interpretation of their own personal, social and cultur

al materials (Goodman 1970). Child psychologists are also interested

in children's views which provide insight into child development and

psychopathology.

In spite of interdisciplinary interest, empirical material

focused on children's ideas of sexuality or birth has been sparse un

til the 1960s. Even though information has been available about sib

ling reaction to newborns, not until 1977 did researchers investigate

reactions of siblings who were present at childbirth to the birth

events. Research regarding children's ideas about sexuality and

birth and research about the reactions to birth and babies of sib

lings present and absent from childbirth are reviewed in the follow

ing sections.

Children's Concepts of Sexuality and Birth

Freud ([1908] 1959, p. 209) devoted a special study to chil

dren's concepts of sexuality. Even though he considered direct re

ports given by children to be "the most unequivocal and fertile source, his material rarely included direct observations and interviews of children. Followers of Freud eagerly accepted his hypotheses about children's sexuality, for example that (1) boys believe in the univer sality of the penis; and (2) children believe babies are born through the anus, and therefore are created in the mouth. There was no 16 reported empirical investigation to test whether the concepts of sex uality determined by Freud corresponded to what children think and believe.

Piaget (1928) asserts that children's ideas about the origin of babies Should follow the same sequence of cognitive developmental stages as their ideas of physical causality. His assertions are not based on any systematic collection of material which he justifies by claiming that questioning of children in this domain was contra- indicated by moral and pedagogic considerations. According to Piaget

(1960), at first children are not interested in knowing how a baby is made, but rather consider the baby as always having been in existence— the concept of pre-artificialism. Later, children combine artificialism and animism, and believe babies are produced limb by limb.

Often, at approximately the same time, children grasp that babies are created in their parents' bodies.

Conn (1947) investigated Piaget's assertion using doll play as an interviewing technique with 100 children ranging from four to eleven years of age. He concluded that preschool children cannot con ceive of a baby in the mother, that sex information is beyond the grasp of seven-to eight-year-old intelligent children, and that not until age nine or ten do children notice and discuss the mother's bulging abdomen during pregnancy. Bernstein and Cowan (1975, p. 77) disagreed with his conclusions: "It is certainly our impression, 25 years later, that younger children are more knowledgeable than Conn suggested." 17

Two more recent studies directly investigated both Freud's and

Piaget's hypotheses regarding children's ideas about birth. Both

studies refuted some previous claims of Freud and Piaget. Kreitler

and Kreitler (1966) and Moore and Kendall (1971) in a replication study

used a standardized interview format with a narrow age range (4 to 5.5

years; 3 to 5.5 years). Kreitler and Kreitler (1966, p. 364) concluded

that "less harm is done by the careful,questioning of children than by

scientific hypotheses devoid of empirical basis." They found that

among 185 four-to five-and-one-half-year-old boys and girls from Euro

pean, North American, North African and Asian ancestry, "the level of

information about sexual differences and the readiness to talk about

sexuality are much higher than usually assumed (Kreitler and Kreitler

1966, p. 363)." They found no evidence for a belief among children of

"pan-penisism" or that birth occurs through the anus. They did con

firm Freud's theory about the creation of babies in an oral manner.

In agreement with Piaget, Kreitler and Kreitler (1966) found

that children believe in the independent pre-existence of babies.

Their data did not confirm the concept of artificialism. Three expla

nations emerged for the creation of babies: (1) in the mother's belly

from the food she eats; (2) always existed in the mother's belly; and

(3) swallowed by the mother. Children in the study explained birth

mostly through the concept of opening the belly, which "may possibly

lie at the core of the neurotic anxiety of pregnancy.... The patho

genetic danger concomitant upon some of these concepts becomes evi

dent when we remember that the infantile concepts are generally not 18 corrected through knowledge acquired later, but merely covered up by it

(Kreitler and Kreitler 1966, p. 377)."

Bernstein and Cowan (1975) researched children's ideas of the origin of babies. Systematic normative data were gathered directly from well children. Beginning with Freud, there has been no shortage of adult opinions on the subject, but few empirical studies have been done with children. According to Bernstein (1973, p. 4): "The dearth of empirical studies about children's thinking about human reproduction reflects the cultural discomfort that lingers over the topic of sex uality, especially as it appertains to children."

Bernstein and Cowan (1975, p. 78) studied children's concepts of "how people get babies" by interviewing 20 upper middle class Cau casian boys and girls at each of three age levels (3 to 4 years, 7 to

8 years, 11 to 12 years); "given the hesitance of many parents to have their children questioned about sexual matters, random sampling was not attempted." The children were also given Piaget-type tasks assess ing physical conservation-identity (clay), physical causality (origin of night), and a new social identity task. The interdependence of the content of the children's concepts regarding how people get babies with

Piaget's concepts of conservation, causality, and identity was demon strated in the agreement of qualitative and quantitative data. The re sults cast light upon children's thinking about birth and reproduction.

The qualitative data obtained by Bernstein and Cowan (1975) also support Piaget's interactive theory of development. "Specifical ly, 'sex information' is both taken in (accommodated) and radically transformed (assimilated) on the basis of the child's experience, af

fect, and cognitive structural level (Bernstein and Cowan 1975,

p. 90)." The conclusions support Piaget's original hypothesis that

children's concepts of how people get babies follow a Piagetian de

velopmental sequence. The conclusions have practical implications for

sex education of children. The results strongly suggest that children

actively construct their notions about babies without waiting to be

told. What appears as misinformation may be a "product of their own

assimilative processes at work on materials with too complex .a struc

ture for them to understand.... Further study is obviously needed

before it is possible to guide children along the path from their

present level to a more differentiated picture of human conception

(Bernstein and Cowan 1975, p. 90)."

Bernstein (1978) has consolidated her research into a book for

professionals f<"d parents. Using a Piagetian framework, she elabo

rates on the six stages of development of children's ideas about the

birth of babies, showing how their ideas follow the same laws as their

cognitive development in general. She believes that not knowing about

birth can lead to upsetting thoughts. Many misunderstandings are harmless and are easily outgrown; however, others become lingering concerns. She recommends that sympathetic, understanding, open adults can help reduce children's confusion. "Learning what children are

thinking helps adults make sure the foundation for understanding is

sound before going on to build elaborate explanations (Bernstein

1978, p. 25)." 20

In a recent study Goldman and Goldman (1982) essentially cov

ered the same areas as Bernstein and Cowan (1975), but they increased

the sample size to 838, extended the sample in age from 12 to 15 years, and randomly sampled in public schools in Australia, England,

North America and Sweden. On a Piagetian scale, sequences of opera

tional thinking were found with increasing age, which confirmed the findings of Bernstein and Cowan (1975).

Cross-cultural differences were observed in answers to the question: "How are babies made?" Swedish children achieved concrete operations at 9 years of age, English and Australian children at 11, and the North American (United States and Canada) children caught up at

13 and 15 years of age. Cross-national differences were postulated as due to the amount of sex education in schools. Sex education in North

American schools has been much more controversial and inhibited due to religious and political pressures. Goldman and Goldman (1982) conclud ed that children construct their own explanations and myths when they are deprived of honest answers. They found that old myths, for example, storks bring babies, have been replaced by new myths, which are

"becoming medical in nature, reflecting the power and mystique asso ciated with doctors, nurses, operations, hospitals, and the secrecy surrounding them (Goldman and Goldman 1982, p. 514)."

The studies reviewed in this section primarily tested hypothe ses proffered by Freud and Piaget. Some of Freud's and Piaget's assertions were confirmed and others challenged. Disagreement exists as to the implications of the findings.

Do children need more or less information regarding sexuality and

birth, and at what ages? How does general knowledge about children's

concepts of sexuality and birth relate to specific life experiences,

such as becoming a sibling? Research studies addressing the topic of

becoming a sibling are discussed in the following section.

Birth in the Family: Becoming a Sibling

Growing up in a family context including brothers and sisters

is an experience shared by 80 percent of American children (Mussen,

Conger, and Kagan 1974). Becoming a sibling in early childhood is a

very common experience, and one with lasting implications.

Moore (1969) compares the sibling experience of birth in the

family with the uncommon childhood experience of parental death, claiming that either experience has a similar significance for later

personality development. Moore discusses several types of stress in normal childhood, with one type being relevant to participation of children at birth. Moore (1969) notes stress arising from events re

quiring adaptation to an unfamiliar situation or new routines and

events affecting the behavior of all family members. A caveat is

given to researchers studying stressful events to children regarding

over reliance on parents' reports. Parents "prefer to present a favorable picture of their children and to minimize the impact of any stressful experience for which they feel in any way responsible (Moore

1969, p. 237)." 22

Bibring (1959) views pregnancy and childbirth as a "normal crisis," which has the potential for specific maturational gains for the entire family as a group, and for the individuals involved. Trause and Irvin (1982) report that children show spurts in independence or mastery after a sibling is born. Nevertheless, for some children the experience of becoming a sibling is likely to be among the most stress ful of early childhood (Legg, Sherick, and Wadland 1974). Common re actions of children to the birth of a sibling which are described in the literature include hostility directed toward the mother or baby, regression, and efforts to gain attention.

Legg et al. (1974) referred to Henchie's (1963) study of the reactions of 66 children to the birth of a sibling. Negative reac tions were found in 89 percent of the children under three years, but in only 11 percent of those over six years. The older siblings' re actions worsened as the infants became mobile and disrupted play. This finding was also supported by Sostek and Read (1979), in their study of reactions of 85 firstborns between one and six years of age to the birth of a sibling.

Trause (1978) assessed the reactions of 37 firstborn children between the ages of one and three and one-half years by direct obser vation of mother-child interactions and by questionnaires filled in by the mothers. The children showed significantly more problems after the sibling birth, for example, sleep disturbances, temper tantrums, and excessive activity. Ninety-two percent (n=34) of the children showed at least one negative change in reported behavior; 54 percent 23

(n=20) showed at least three. The largest increase in problems oc

curred in sleeping patterns. Significant improvements were noted in

eating patterns.

The studies reported in this section have been concerned with

siblings' reactions to new brothers and sisters where siblings were

not present at the birth. Becoming a sibling has been generally re

garded as an event to be reckoned with—ranging in stressfulness

from extremely traumatic to a "normal crisis," depending on the author.

Behavior changes have been frequently reported following the birth of

a sibling.

The present study is intended to learn the child's view, not of human reproduction or of birth in the abstract, but of childbirth as described by children who were present when a baby was born. This

particular population of children who have actually witnessed child birth has become available in the United States in the last decade, due to the alternative birth movement. Research studies addressing

this recent phenomenon of children being present at birth are discussed

in the following section.

Sibling Presence at Birth

Mehl, Brendsel, and Peterson (1977) carried out the first study about siblings who were present at childbirth. They compared the attitudinal and emotional reactions toward birth of 20 children who were present at birth with 20 children who were not present. The chil dren ranged in age from two to fourteen years. Naturalistic 24

observations were made of children present at childbirth, as well as

children at play. Mehl et al. (1977, p. 275) suggested that the pres

ence of children at a delivery permits an open attitude toward birth

as a normal process in families where childbirth is accepted as

normal:

All the children who were present at birth tended to have accurate notions as to how babies were born, and tended to discuss the process in a matter-of-fact manner with enthusi asm and positive affect. Some of the six-to ten-year-olds reported being somewhat afraid of even small amounts of blood present, and two turned away at the moment of birth because of this. The older children reported feelings of pride in their mother and amazement at the actual process. The younger children were more matter-of-fact as though this was how things were and how things had always been.

The behavior of the children who witnessed labor and birth var

ied with age. Young children tended to wander in and out of the room.

The six-to ten-year-olds were more thoughtful and more involved than

the younger children, whose first concern was for their mother. The younger children needed more extended contact with their mothers be fore directing attention to the baby. The six-to ten-year-olds tend ed to be more verbal and asked more directed questions.

Children who did not witness birth tended to have fantasy ideas about the infant's arrival, for example, anal, umbilical, or oral regurgitation births. They were puzzled and mystified in spite of the information made available to them.

Anderson (1981a, 1981b) completed two studies in 1978 regarding the presence of children at childbirth. The first study compared two groups of parents of newborns who had older siblings. In one group of 25 families the siblings were present at birth (n=43). In the compari son group of 25 families, the siblings were not present at birth (n=39).

The siblings ranged in age from one to sixteen years. Data were gathered from parents using an interview protocol. From the parents' point of view, 93 percent (n=40) of the children who were present at births were described as being curious, calm, supportive, and ex cited. Nineteen percent of the children who were present at births showed regressive behavior, compared with 33 percent of the children who were not present. Abusive behavior was described by parents in 16 percent of the children who were present at birth and in 33 precent of children not present.

The overall reaction of the children present was considered positive without qualification in 22 out of 25 families. Two children were considered to have a qualified positive experience; for example, one two-year-old who was awakened in the middle of the night for the birth clung to her father. Another example involved a three-year-old who was shocked by the blood. The one negative experience happened when a three-year-old was removed from the home against her will during labor—before the birth of the baby.

Realizing that parents could present a biased, positive picture as a way to support their decision to include children, in the follow- up study Anderson (1981b) interviewed the children themselves and ob tained two drawings from each child: a picture of a baby being born and a picture of the family. Fifty-eight boys and girls ranging in age from two to seventeen years provided data. Of the 58 children, 57 were

Caucasian and nine had one or both parents of Mexican ancestry. One adopted child in the study was black. Questions focused on the child's perception of birth, parents and the newborn. The drawings and re sponses of children who were present at births revealed that generally the children were eager, enthusiastic, and accepted the experience with equanimity. Of the children who were eager to assist with simple tasks, such as bringing cool cloths and rubbing their mother's back, most were in the six-to nine-year-old age range, which corresponds with Erikson's (1950) stage of industry versus inferiority seen in six-to twelve-year-old children.

The children who were present at births (n=31) generally drew a family scene for the birth setting, which often included other people, usually the father and/or children. They also included flowered sheets, bright colors and faces with smiles. In contrast, the pic tures drawn by children not present (n=27) rarely included other family members (one picture included a father and no pictures included chil dren). These drawings lacked color; however, great attention was given to technical equipment, such as stirrups, intravenous solu tions, and oxygen masks. The differences in the drawings indicated that children who had been present at childbirth viewed birth differ ently from those children who had not seen birth. These differences suggested the need to study the child's-eye view of childbirth in depth. 27

Hathaway and Hathaway (1978) examine some of the factors to con sider when deciding about the presence of children at birth. From a lay perspective, they suggest how to prepare children and parents, based on interviews with families, observation of children at birth, as well as on their own personal family birthing experiences. They consider viewing birth as positive sex education—an opportunity to learn to respect birth, not to be embarrased by it. The Hathaways be lieve children at birth learn to handle hard work and pain along with possible rewards. Children learn to help and be part of a team by massaging, getting ice chips, or caring for other children. Many families consider sibling participation in childbirth as a way to foster certain values.

In order to avoid negative or shocking effects, the Hathaways

(1978) recommended accurate and matter-of-fact communication based on the child's cognitive level. In spite of preparation, their own

13-year-old daughter felt angry that her mother had to go through such painful experience. Their daughter made her own suggestions for pre paration of children; for example, watch natural childbirth movies and make children feel important and useful by giving them tasks. The daughter listed three things that scare "kids": baby was blue when it was born, baby didn't cry immediately; thought it was too bloody. She recommended discussion of these items. She felt no one should be forced to be at birth, especially children, as some "...aren't ready. Some adults can't take it either (Hathaway and Hathaway 1978, p. 106)." The book also included other personal stories of children at various ages. An eight-year-old boy was concerned about his mother being exposed during the birth, so the mother and child bought an appropriate gown. The mother stated that "when the time came for the birth and I was considerably exposed, this did not bother Robert at all. The time was right and it was all right at this time to be ex posed. There is a time and place for everything (Hathaway and Hathaway

1978, p. 20)." This anecdote presented the parent's view of the child's concern and reaction. The philosophy of the Hathaway family and of the book was summarized in the following quote: "Birth is for babies, children and other loving beings, who see the wonder and beauty of life

(Hathaway and Hathaway 1978, p. 107)."

A research team at the Mt. Zion Hospital Alternative Birth

Center (ABC) in San Francisco has studied several issues involved with the inclusion of siblings at childbirth, an alternative offered to families at the ABC since 1976. During the first three years, 88 families (14 percent) out of 629 families included siblings at births

(Irvin et al. 1981).

Out of the 88 families including siblings, 71 families partici pated in the first study. In order to investigate the motivation of parents to include children, the researchers interviewed an unspecified number of children and parents separately before and after the birth.

"Reasons for wanting to include siblings at birth fell into three main categories: (1) opposition to traditional exclusion of children from birth; (2)concerns about a more natural transition for older siblings; and (3) concerns about sibling rivalry (Ballard et al. 1982, p. 105)."

The first category included families opposed to the exclusion of chil dren. These families were characterized as "against hospitalism."

Such families considered inclusion of siblings as an attempt to human ize the birth experience. Families who fit in the second category were concerned about the older siblings and were characterized as "for families." The motivation for these families to include children was to strengthen the family unit. The third category included "a small number of families" who were primarily motivated by the hope that sibling rivalry would be diminished.

A second part of the study focused on the behavior of children present at birth. The researchers observed the behavior of 40 chil dren, ages one to fourteen years, during labor and birth. Children were rated on an adjective checklist according to the degree of in volvement with the mother during the different stages of labor.

Twenty-five of the 36 awake children asked questions of their mothers and timed contractions during early labor. During late labor, chil dren drew back and observed. Twenty-nine of the 38 awake children watched during the birth, a few watching intermittently.

All the children of the mothers who made sounds during labor noticed the sounds and less than half appeared upset. One child seemed distressed about the repair for episiotomy or laceration, although most ignored this procedure and focused on the baby. Leonard et al. (1979, p. 950) concluded that "no child displayed extreme distress while present at the birth of a sibling, but some parts of labor and delivery did seem to be somewhat distressing to some chil dren." They did not report data regarding what parts of the birthing process were distressing to children and to what degree they were distressed. Variability in children's views of birth according to age and sex was also not reported. Leonard et al. (1979, p. 951) concluded from their initial observations of the behavior of children at the birth of a sibling "that childbirth is primarily an adult event. When children are present, it appears to be a wish of their parents that they be there. Children watch the process, attend to the infant, and then are quickly ready to resume their regular activ- ties."

Irvin et al. (1981) conducted a follow-up study with 18 fami lies. A semi-structured interview utilizing a questionnaire elicited reports of behavior changes in 22 children who had been present at the birth of a sibling one to four years previously. All families report ed overt rivalry. Despite the rivalry and some behavior changes, parents uniformly felt that including children at birth had increased sibling attachment and therefore they would include a sibling again.

Fragner (1979) sought to develop a theoretical model for ex amining the psychological implications of children's participation in birth by using a case study method with five families. This approach allowed for an in-depth exploration of the families' experiences in cluding siblings at birth. She concluded that a positive or negative interpretation of the birth seemed to be based on the fulfillment of needs for autonomy and affiliation. She also found that conscious motivation to include children at birth seemed to stem from a strong commitment to the family structure, and from a perception of child birth as a natural healthy family event. She noted that families who choose to include children value direct and matter-of-fact com munication about sexual matters, and view the birth of a baby as part of that communication process.

In conclusion, the studies regarding siblings presence at birth generally reveal children accepting birth with apparent equa nimity, with a few exceptions of restlessness, distress due to blood, sounds of mother, and concern for mother during the episiotomy. On the whole, parents state they would repeat their decision to include children.

One difficulty with studies of children's reactions to child birth and new siblings is the multitude of variables that influence the reaction. Legg et al. (1974) are aware of the many variables that enter into a study of the reaction to sibling birth when the mother is hospitalized: separation from the mother, increase or de crease of father involvement with the child, different caretaker, and even a possible change of living quarters. Leonard et al. (1979) believe the long-term effects of siblings being present at birth may depend on a number of factors, such as the family dynamics prior to the sibling's presence at birth, the birth event, and the new sibling impact on the family structure. 32

Other variables of interest are age, gender and ethnicity of children and how these influence their reactions to childbirth. Chil dren of various ages have different reactions to birth; for instance, preschoolers are more matter-of-fact and older school age children are more able and willing to actively participate. Several studies

(Mehl et al. 1977, Anderson 1981b) have noted that school age chil dren, approximately ages six to twelve, are more willing and able to share their views verbally and in pictures.

The studies that have been cited demonstrate the importance of learning the child's-eye view of sexuality and birth. The more recent studies, most of them exploratory in nature, have focused on those children who have been present at childbirth. The literature suggests that children's views of birth are different from those views of adults. What are the views of children who have witnessed child birth?

This chapter has presented studies that have been carried out in Western cultures. The following chapter will present ethnographic information available about accessibility of childbirth to children in non-Western cultures. CHAPTER 3

ACCESSIBILITY OF CHILDBIRTH TO CHILDREN: CROSS-CULTURAL COMPARISON

This study describes the child's view of birth in a contempo

rary United States cultural scene as a contribution toward under

standing one particular view, the child's view, of a significant

sociocultural event, namely childbirth in one society. What is the

child's view of birth in other societies? Due to the lack of in-depth

studies in the ethnographic literature on the sociocultural aspects

of childbearing, especially regarding the child's view of childbirth, it is not possible to compare the child's view of birth cross-cultural ly-

At present the ethnographic literature lends itself to a survey

approach only to the topic of accessibility of childbirth to children.

It is possible to describe the role of children and their attitudes in only a very few societies. In the future, if the trend toward attending to rich social context of childbirth continues, it will be possible to look at a large number of traits and trait complexes in relation to children's participation at birth in order to help understand why society X prescribes Y and another does not.

33 34

The ethnographic literature indicates a broad range of cul

tural attitudes and practices regarding childbirth as well as the

involvement of children with birth. In some societies the partu

rient woman is completely isolated from her family and goes off into

the bush to give birth alone, for example, the !Kung Bushmen; in

other societies people pattern birth as a social event openly accepted

by the community, for example, the Pukapukans. This chapter discusses

the sociocultural influences on birth practices, accessibility of

childbirth to children in selected cultural units, and other indica

tors of cultural attitudes toward birth, such as children's games, and artistic depictions. Historical documentation is also reviewed.

Sociocultural Influences on Birth Practices

The way in which childbirth is viewed by individuals undoubtedly depends upon the culture in which it occurs; however, the ways children view birth cross-culturally have not yet been explored. Adult percep tions of children in relation to childbirth are scant. Undoubtedly, the way adults react to children's participation at birth is closely re lated to the ways adults react to pregnancy and childbirth in general.

In no human society do the events of pregnancy and birth pass un noticed. Usually these events are invested with strong feelings.

The numerous ways of patterning childbearing are dictated to a large extent by the ways in which the cultural group perceives the event. Specific practices reflect not only the particular ethos surrounding birth, but larger cultural values, such as whether birth is perceived as sacred and blessed or dirty and shameful or whether

birth is considered a public community affair or a private secret

event. These perceptions of birth determine who should and should not

be present at labor and birth, and where and how labor and birth

should be conducted (Scheper-Hughes n.d.).

Mead and Newton (1967) describe ways that different cultures

react to pregnancy: (1) feelings of responsibility for fetal growth;

(2) feelings of heightened solicitude toward the pregnant woman; (3)

pregnancy as evidence of sexual adequacy; (4) pregnancy as a time of

vulnerability and debility and (5) pregnancy as a time of shame and

reticence. Shyness about pregnancy may also be related to feeling of

embarrassment or shame about the sexual intercourse that precedes it.

According to Ford and Beach (1951) feelings of reticence about

coitus seem to be very widespread. Frequently there is a feeling that

coitus should be practiced at night, in the bush, on the beach or in

some other remote area. Reticence about coitus during pregnancy can

also be an indicator of feelings of embarrassment or shame surrounding childbirth, which can be related to the level of participation of chil dren at childbirth. The Cuna, a polygynous society of Panama, and the Pukapukans, who inhabit three islands north of Samoa in the

Pacific, serve as contrasting examples of reticence toward pregnancy, normalcy and privacy surrounding childbirth and the level of participa tion of children in the birth event.

The Cuna, according to Ford and Beach (1951), exemplify the most ex' :eme position of reticence about coitus during pregnancy. The Cuna demand cessation of sexual relationships as soon as the woman has missed one or two menstrual periods. Such a severe re striction is most common in polygynous societies. In addition the

Cuna regard childbirth as not only abnormal, but also dangerous, to such an extent that the mother goes to the shaman daily during preg nancy and is treated with medicine during this time, as well as dur ing labor (Marshall 1950). Childbirth among the Cuna is extremely secluded. Children are strictly excluded not only from childbirth, but also from any knowledge concerning sex or birth. They are not al lowed to see even dogs, cats or pigs give birth. It is not until the last stage of the marriage ceremony that the Cuna are told about the existence of sexual intercourse and the reality of childbirth

(Stout 1947).

In contrast, the Pukapukans show little, if any, reticence about pregnancy or childbirth. They may continue sexual intercourse until parturition starts (Ford and Beach 1951). Children may witness coitus at an early age as they sleep under the same mosquito net with their parents. A casual attitude about childbirth exists, and there are no prohibitions in regard to attendance at childbirth. It is open to all who feel inclined of any age or either sex (Beaglehole and

Beaglehole 1938).

In these two societies, the Cuna and the Pukapukans, it seems the greater the restriction of sexual activity during pregnancy, the greater the privacy surrounding birth. Both of these cultural traits in these contrasting societies are inversely related to the level of participation of children at childbirth. If more data on these cul tural traits were available for other societies, a cross-cultural correlational study could be pursued.

Cultural Differences through Space and Time

In order to determine cultural differences through space and time in the participation of children at birth a review was made of the

Human Relations Area Files (HRAF).

Human Relations Area Files Survey

The review included all of the cultural units available in the

University of Arizona HRAF microfile collection in 1981 (approximately

300 cultural units). Category 844, Childbirth, in the Outline of

Cultural Material (Murdock 1971) was selected to glean information about the location and activity of children at the time of childbirth in the family, kin group or village. Category 844 is a sub-category under reproduction, which belongs to the major section entitled Sex and the Life Cycle. Category 844 includes information on place of birth, witnesses, assistants and excluded persons, as well as material on ideas about childbirth, attitude of the community, preparation for delivery, and role of midwives.

In the area of sociocultural aspects of childbirth, there are obstacles to collecting data from secondary sources for the purpose of cross-cultural comparison. In general, there is a paucity of recorded information in the ethnographic literature on birthing practices. The available information is often biased and restricted to limited areas. 38

The biased data result from medical reports that focus primarily on abnormal births. These abnormal births have usually been viewed from a medical perspective with an orientation to pathology. Medical sources usually omit mention of the environmental, cultural and emo tional settings in which birth occurs. Mead and Newton (1967), in checking the cultures included in HRAF, have noted that almost two- thirds of the files contain no description of normal birth at all, no matter how cursory.

Frequently male anthropologists or even female anthropologists without children did not have access to birth events or were not inter ested in them. For instance, Mead (1956) remarked that during her earlier field work in Manus in 1928, she was unable to see a birth be cause she herself had no children. Morris (1938, p. 207) studied the

Lepcha of Asia. He commented that "during the time of birth no man is present in the rocm, and the subject is naturally an impossible one for a male to investigate." Nevertheless, he provided a rich descrip tion of the recollections of an adult informant relating his childhood birth experience. Williams-Hunt (1952, p. 28) also felt the restric tion of being male when attempting to describe birth among the Sakai:

"Gentlemen are not generally welcome at births and as we have no recent eyewitness accounts by reliable observers, I shall have to fall back on descriptions given by the Aborigines themselves."

Vanoverbergh (1936-38) wrote about the problems of obtaining re liable information about birth because all the informants were men, and men had no business to be present at the exact moment of childbirth. 39

Hogbin (1943, p. 290) also used male informants who would "never on any account approach while birth was in progress."

As a result of limited access and interest, there is a gap in the ethnographic literature regarding sociocultural aspects and support systems, which were often female networks. Ethnographic description is also scarce in the area of childhood, especially related to child birth. Schlegel (1977, p. 2) comments: "One gets the impression from many ethnographies that culture is created by and for men between the ages of puberty and late middle age, with children, women and the aged as residual categories...."

Another problem resulting from the use of secondary sources is the tendency for a single first-hand observation to be reported as normative. There is no way to know if the situation described is de viant, modal or representative of the culture at large. In addition, it is difficult to discover intracultural variation regarding the accessibility of children to childbirth.

The review of approximately 300 cultural units revealed infor mation about accessibility of childbirth to children in 50 societies

(Table 1). The information was found in six of the eight major world areas, as delineated in the Outline of World Cultures (Murdock 1972). 40

Table 1. Major world areas, cultural units, and accessibility of childbirth to children.

World Areas Cultural Units and Accessibility of Childbirth to Children

Information Access to No access Variable available birth to birth practices

Asia 6 3 0 3

Africa ' 5 1 2 2

Europe 0 - - -

Middle East 0 - - -

North America 12 1 10 1

Oceania 14 . 9 2 3

Russia 2 0 2 0

South America 11 6 2 3

Total 50 20 18 12

Table 1 illustrates the accessibility of birthing events to children in cultural units in the eight major world areas. Oceania

(n=14), North America (n=12) and South America (n=ll) are the three major world areas which provide the bulk of information about the location and activity of children during childbirth. 41

Children are considered to have access to births if they are

present in the room, allowed to pass through, or wait in the immediate vicinity, for example, on the other side of a hanging mat (n=20). No access to birth by children includes those cultural units that explic itly exclude children from viewing or being near the location of birth in any way (n=18). Variable practices refers to those cultural units which allow access to some, but not all, children (n=12). For exam ple, according to age, sex or geographic location, cultural rules vary in who is allowed access to childbirth.

Appendix A displays each of the 50 cultural units, including information on accessibility of childbirth to children. Appendix A also provides the code from the Outline of World Cultures (Murdock

1972), the name of the ethnographer and the date of publication. The complete bibliographic citation for each cultural unit is listed in the references. The next section describes the accessibility of child birth to children in 50 cultural units in six world areas as available in the Human Relations Area Files..

Asia. For Asia the HRAF yields information on access of child birth to children in six cultures: Ainu, Lepcha, Laos, Malays,

Central Thai, and Burmese. The Ainu traditionally give birth to the first child in the mother's natal home, but later births occur in the husband's home. They are attended by a midwife and/or several female re latives. If a midwife is not available the husband assists by placing a carved stick in the hearth as sacrifice to the goddess of fire and by clasping a string around the woman just below the chest as a remedy for pain. The Ainu do not hide anything from their children, who know ex actly how childbirth takes place. For that reason it is unnecessary to lie to them later concerning the arrival of a new sibling (Pilsudski

1910).

Among the Lepcha, childbirth takes place in the husband's house. All members of the household are expected to be present at the birth. No strangers are allowed unless a "lama" is called to help with a difficult delivery. A rope is suspended from the kitchen ceiling.

The mother squats and clings to the rope, supported from behind by the father or anyone who knows her. This person presses on the woman's breasts and belly. Children normally witness the births of siblings, as well as other children born in the household. Children do not seem to regard childbirth with any deep emotion. One twelve-year-old ex pressed the general sentiment of all children when he maintained that during birth he was not frightened, even though he was anxious for his mother. Another child voiced the matter-of-fact opinion that first of all a woman becomes pregnant and then she puts out a child. It seems that only single children or adopted children who have not had the opportunity to witness childbirth approach the situation with any emo tion or curiousity (Gorer 1938).

Morris (1938) found it difficult as a male to investigate childbirth among the Lepcha. However, an informant confided to Morris 43 that when he was a boy (about 8 or 9 years old), he was very anxious to see how babies were born. His informant related how one day he went unnoticed to a house specifically to witness a birth event. The house had a floor of bamboo slats. By standing underneath and looking up he was able to see everything. His recollection of his boyhood perception follows:

The woman was holding onto a rope, which was suspended from the roof, and was herself being held from behind by another woman. I first saw a large round object appear, which was ap parently the baby's head. Everytime the mother grunted a lit tle more appeared; but when she ceased to grunt the whole object appeared to contract and disappear. There was complete silence for a bit and then the object seemed to shoot out of the woman's body with great rapidity. I saw that it was the baby.

I noticed that the woman's vulva was very large and round; but I was not frightened nor did I feel the least shame. I think I really did not think about the matter at all. I sup pose I must have been about 8 or 9 years of age at the time this happened. I only went because I was very interested to see how a baby was born, and because I wanted to see what a woman's vulva was like. I could not now watch this sort of thing, as it would have too exciting an effect on me (Morris 1938, p. 207).

A Laotian labor includes relatives and friends, or more often young men, according to Reinach (1901). The assistants hold up the laboring woman and attempt to divert her with licentious remarks.

Young men bring musical instruments and phalli, the focus of witty com ments to amuse and divert the parturient woman. She responds with out bursts of laughter despite her pain.

Among the Malays, birth is described as an occasion, not for seclusion, but for the assemblage of all relatives and neighbors. The mother sits on a mat in a room adjoining the kitchen, and has a tight

band of six-inch cloth tied around her waist to prevent the fetus

from rising up and delaying the birth. A midwife might quietly per

form a series of massages, while women friends stand around chewing

betel. The husband waits nearby in order to carry the woman from

the mat to a nearby bamboo bed. The atmosphere is now relaxed and

the air filled with exuberance. The husband sits down and smokes,

and the other sons come in. The mother is "put to roast" near a fire for her circulation, and is served hot water and tumeric for their warming and cleansing effect (Djamour 1959, Winstedt 1922). The ethnographic literature does not reveal anything about the whereabouts of girls in the household.

Central Thai women are described as having a positive, secure and relaxed outlook on childbirth, as well as an understanding and acceptance of suffering so that they had little fear. Ample help is available during childbirth from female relatives, but anyone—young or old, male or female, kin or not—might be asked to help. Childbirth occurs in a small room constructed for private needs, such as a mar riage chamber, a quiet room for senile parents, or a storage for val uables. If such a room is not convenient, the birth occurs in the main part of the house (Hanks 1963).

In Burma, at the time of birth, relatives come of their own accord to offer help. Most of the visitors are women and girls. Very few young men come. If a pregnant woman is in the house at the time of birth, she must depart as the progress of labor might be impeded by her presence (Brant 1954, Orr 1951). 45

In the six Asian cultural units with information about children and childbirth, all give access to children, with three units specify ing boys, girls, or young men. The ethnographies do not mention the exclusion of children of either sex or any particular age.

Africa. In the African world area, there is information about children and childbirth in five cultural units: Chagga, Pygmies,

Azande, Bushmen and Zulu. The Chagga surround birth with secrecy.

Children are told that babies come from a beehive in the forest or steppe, or that an animal brings babies. Gutmann (1926) relates a

"disgraceful" incident from earlier years: it seems a married man, while conversing with minors, answered their questions about the origin of man by disclosing that man happens to be born, a closely guarded secret among the Chagga.

Among the Pygmies, birth is primarily the affair of the nuclear family, although all members of the band share the pride and pleasure of the parents. Turnbull (1965) describes one birth where the children were playing about and running in and out of the hut where the pregnant woman was kept. Even though the woman in labor was in great pain, she never uttered a complaining word. Finally, she was made to sit on a log while one woman sat behind her and held her up and another massaged the infant out. Even though the father should not usually be present, dur ing the whole period of this particular birth, the woman's father and husband were with her constantly.

Among the Azande, custom determines little regarding childbirth.

The husband consults the rubbing-board oracle to determine whether the birth should take place in her own hut or in her father's or brother's

homestead. The midwife is also chosen by the oracle, as well as other

attendants, such as the mother, another relative, neighbor or even the

husband (Seligman 1932). Visitors are kept outside the place where

the mother is. Anderson (1911) notes that assistance during childbirth might be given by small boys.

Among the !Kung Bushmen a woman goes into the bush by herself,

except for a first birth, when she first feels birth pangs. She picks

tufts of grass and places them upside down on a tree as a warning to men and children that labor is in progress. The woman prepares a

place under the tree, grasps a branch with her hands, and gives birth

in a squatting position. Children may not observe birth. If they creep up out of curiosity, they are soundly thrashed (Lebzelter 1934).

Childbirth among the Zulu is primarily the concern of women, especially older women who stay and sleep with the expectant woman so as to be ready for midwifery duties. Birth initiates some companion ship taboos, according to Raum (1973). Among those forbidden to enter the mother's hut are the husband, the male-in-laws, especially the father-in-law, and all pubescent boys and girls. Free access is granted to small children, both boys and girls, and the woman's co- wives. The husband remains nearby, but it would be awkward for him to see the woman's private parts, as well as the blood and the newborn.

Raum (1973) writes that such things look filthy to men but not to women. (Presumably also not to young children.)

In the five African cultural units with information about chil dren, there is wide variation ranging from complete openness among the 47

Pygmies to complete exclusion among the Bushmen and Chagga. The Azande

appear to allow small boys as helpers, and the Zulu allow small chil

dren access to birth, but exclude those in puberty.

North America. In the major world areas of North America, there

are 12 cultural units in HRAF with information about access of children

to birth. Children are explicitly excluded in ten cultural units and

are included in only one. The data describing Navaho practices are

conflicting.

Women are not secluded during childbirth among the Copper

Eskimo. The woman delivers in her own hut, tent or home in the pres

ence of her husband and several female relatives, who may try to press

the baby out if there is difficulty. The child is ever afterwards con sidered the foster-child of all who assisted at the birth. Children are not given access to the place of confinement. If it happens that a child is present in the house of women who has just had a baby, the child must stand outside the entrance passage, turn their head toward it, and hop and dance on one leg and then the other (Rasmussen 1932).

Hara (1964) briefly describes childbirth among the Hare from former times. During labor all women in the camp gather in the mother's tent and help her. The men and children usually are not in volved unless no women are around to assist.

The location of birth for the southern Ojibwa depends on the season of the year. If the pregnancy ends in late fall or winter, the birth happens in the home wigwam of the permanent camping grounds.

However, if there are preadolescent girls or boys in the family, then a 48 small wigwam is built near the home where the woman stays until after the birth in order to be away from the children. If the baby is born in spring or summer, the mother prepares a place in the open away from the home wigwam. If the family is enroute or encamped in a place of food gathering, such as fishing, hunting, trapping, berry picking, wild-rice gathering, or maple-sugar making, the birth also occurs in the open. All women seem to know how to assist and there are always several women present. It is not customary for any man, not even the husband, to be present at birth unless a strong person is needed and no women are available (Hilger 1951).

Among the Montagnais of Naskapi, the birthing woman receives assistance from the mother-in-law where she and her husband most likely reside. Any married women can be called on to help; however, single girls, even the mother's own sister, are strictly excluded from the birth (Lips 1947).

Henriksen (1973) describes the Montagnais of Davis Inlet, who live a nomadic way of life. All the women in camp stay with the parturient woman until the infant is born. No men are allowed at birth, except in one instance, a brother was present as the birth took place in his wind-blown chilly tent. The husband and older children had to stay with another family.

Hilger (1952) describes the witnesses at childbirth among the

Arapaho. The women's father and mother are usually present, plus two to three older women—perhaps one is an experienced midwife and one a medicine woman. Other female relatives might attend and also the medicine man. It is not conventional for the husband to be present.

Girls about 20 years of age can be around, but not young men. "Chil

dren are not to be present on account of the noise they would make

(Hilger 1952, p. 20)." People ask permission at boarding school for

the Arapaho and the Cheyenne to take their children home from school

when a baby is about to be born in the family.

Among the Crow and the Dhegiha, Dorsey (1882) observed be

tween 1871-1881 that during childbirth the husband and children were

obligated to go to another lodge as they were not allowed to witness

the birth, which was attended by only two to three old women. In the

early 1900s Lowie (1935) made a similar observation of Crow husbands.

No males, not even boys, were ordinarily allowed in the lodge at the

time of birth as their presence could delay the delivery.

Among the Hopi at Oraibi, if there are children in the house,

they remain almost to the time when the infant is actually born, but

at the moment of birth they are sent out of the house (Voth 1905).

Talayesva (1942) writes that it was the custom to let the woman stay

by. herself during birth without any children around bothering her.

The children are sent to the neighbor's house. Eggan (1950) relates

that, in theory, the Hopi women should give birth alone, but often she is aided by her mother or even her husband.

Among the Navaho, birth takes place in the home, a hogan. "The hogan is open when a baby is being born....Anyone who comes and lends moral support is invited to stay and partake of what food is available

(Lockett 1939, p. 15)." When the weather is hot, some women deliver 50

children outdoors, in a tent or summer shade. Anyone who is skilled is

acceptable to help. The relationship to the woman in labor does not

seem to be important. Children come and go freely during labor (Bailey

1950).

The age at which girls were expected to help, which varied be

tween 7 and 18 years, was a matter of personal opinion. One woman said

that her youngest daughter helped receive the new infant at the age of

seven. She was not afraid until the baby cried. Another elderly in

formant related that when her daughter was very young, she was fright

ened when she saw her mother deliver a baby. The informant believed

it was not good to let girls see this too young as some women "make a

lot of hollering and it frightens the children (Bailey 1950, p. 50)."

In a Navajo autobiography, Dyk(1938,p. 46) shares part of his

boyhood experiences and puzzlements:

I saw many a baby born at my place. When one was born I'd go close and see that the baby's stomach was full. I wondered how they ate and who'd been feeding them inside the mother. When I saw a baby born I'd look at it closely, and it would have legs, arms, feet and toes, hands and fingers and a head just like mine with hair, ears, mouth, nose and eyes, and it would have a body exactly like others. I used to wonder, what makes them that way? Who in the world makes these babies? It must be someone. Maybe someone makes them that way first, and then, afterwards, they must be put inside their mothers. Or, I thought, someone must make them that way inside their mothers. Or maybe that's the food she eats. When the mother eats the food it must get that way and turn into a baby! When I saw that a baby had everything, just like the rest of us, it wor ried me a lot.

Autobiographies are seldom so explicit about early ponderings and specu lation. Children's early questions and comments are seldom either en couraged or recorded, and later, as adults, courage or memory hamper our recollection of childhood curiosities and reasonings. 51

Even though some Navajo children are present at birth, other

Navahos maintain that small children must be kept out of the hogan dur ing birth in order to facilitate a fast easy birth. The children are at times excluded in case one of them was slow being born. This would slow up the birth (Bailey 1950).

Among the Zapotec, Messer (1975) has recently found that child birth information continues to be passed down along generational lines within networks of female relatives. Young Zapotec girls observe medicinal administrations and the birth process, which helps prepare them for the delivery of their own children.

The only people to attend birth among the Tzeltal of

Amatenango del Valle are women of the immediate household. Children are kept out of the house and men usually flee the scene. Women are ashamed of their husbands seeing the placenta because they joke about its size with other men, believing the size is related to amount of male sperm and the number of times of intercourse (Nash 1970).

The Mam of Santiago Chimaltenango believe only the husband, his or his wife's mother, and a midwife should be present at childbirth.

Before the birth, the children of the family are sent to the homes of relatives (Wagley 1941).

The Mam, along with nine other North American cultural units, do not allow children access to childbirth. The ethnographic literature reveals one cultural unit, the Zapotec, allows children access to birth, at least in some situations.

Oceania. The largest number of cultural units (n=14) with ethnographic information on children and childbirth, as well as the largest number of cultural units allowing children in some way to be present at birth (n=12), is found in the major world area of Oceania.

Among the Apayao of Isneg, the parturient woman is assisted by all women who belong to the same household. Even little girls are al lowed to witness the birth of a child, but not so with little boys.

"All men who do not belong to the family are forbidden to enter the house, and even those who live there, whether small boys or adults, have to keep away from the mother (Vanoverbergh 1936-38, p. 91)."

This is easily done, as the houses are roomy. In some localities husbands are an exception to the rule excluding men, even to the point of assisting. In other places the husband is permitted to stay in the house, but has to turn the other way and is forbidden to wit ness the birth of his offspring (Vanoverbergh 1936-38).

DuBois (1944) considers childbirth among the Alor as definite ly women's business, even though men and children are not completely excluded. Although there is no strict rule on the presence of the husband at birth, usually he is not present as a matter of good form.

When labor begins the parturient woman goes to the house of her kins women, preferrably her mother. Birth occurs in the privy-corridor just off the living room where a group of interested kin, both men and women, may have gathered to chat and wait for the birth. Children form a part of this group. The mother sits with legs spread until the baby is born. The mother wraps the infant in soft cloths and joins the group of relatives and friends in the living room. There is no em phasis on modesty or problems in connection with birth, even though in other situations there are strong feelings about exposing genitals

(DuBois 1944).

Childbirth in Bali is described as being easy. Often the

assistance of a midwife is dispensed with and women relatives aid the

woman giving birth. The woman sits on a mat. She is supported from

behind by a woman while another gives a massage. The husband is ex

pected to be present. Men and women freely discuss sexual questions.

Covarrubias (1938, p. 124) writes that women eagerly describe their

childbirth experiences while men add overlooked details, but "the most

convincing authority was Rapag, a boy of 14 who had witnessed the

births of his 4 sisters."

Among the Toradja, the birthing woman withdraws into a little

room with low walls. The other people in the household go their cus

tomary ways. The child is born in front of the housemates walking

back and forth. Children are present during the birth event and know

exactly what happens. The parturient woman is surrounded by housemates

who make the time pass with jokes and all kinds of advice (Adriani and

Kruyt 1951).

In contrast, when an Aranda woman gives birth, she goes into

the bushes away from the hut. The mother and sisters go to see the

laboring woman from time to time, but especially the children, who are

very inquisitive, go to see the laboring woman. The children are not

ordered off, and are often the only human beings present (Schulze

1891).

Among the Wogeo, a birth hut is erected by the husband before

the birth, or by the woman's brother if she is unmarried. The location of the hut depends on whether the pregnant woman already has a young child who is likely to seek her out, which is considered a grave danger to be avoided at all costs. If she already has a child, the birth hut is hidden deep in the forest, far from the village. The child is informed that the mother has gone to see relatives on the other side of the island. When she returns the child is told the mother found a baby in a cave nesting in' a flock of bats. Hogbin (1943, p. 289) reports:

During my visit one of the children in Kinabe village found the hut where his mother was staying and would have run towards her had not a girl, hearing the woman frantically screaming. "Go away! Go away!", come and carried him off. The experience must have been an extreme shock for the boy, and he obstinately refused to go near her for some time after she went back to the village.

Pospisil (1958) indicates that among the Kapauku children are excluded from birth, even though the birth takes place in the open, only a few yards from the house of the husband or of the wife's par ents. The birthing mother squats and male and female onlookers stand around. Only the children are chased away.

Mead (1956) observed the Manus in 1928-1929 and again in 1953.

During this time, changes occurred regarding who was allowed to wit ness childbirth. In 1930 Mead wrote that only women who had borne children were allowed to be present at birth. Men, young girls and children were excluded. The feeling was so strong against the pres ence of women who had not had children that even Mead could not break it down. When she returned to the field in 1953 she had fulfilled the requirement by bearing children, but the rule no longer existed. 55

"Husbands and even small children were now freely admitted to a birth

(Mead 1956, p. 344)

When labor starts for a Buka woman, her husband fetches his mother, who brings some women and their children with her to assist.

Young women who have not yet borne a child should not witness a diffi cult labor, as it might make their own first labor difficult. The husband moves his own bed and few personal belongings out of the hut into another close by. No men are permitted to enter the hut in which the woman is confined from the time labor begins (Blackwood 1935).

Among the Lau-Fiji in Kambara, an attempt is made to keep labor secret in the village, and to keep children out of the sleeping house, the scene of childbirth. If labor is prolonged, children of the village gather and watch nearby. As soon as the baby is born, the children are allowed to enter the house. The husband's relatives assume prolonged labor is due to adultery, but the women are sympathet ic and all agree adultery does not influence the birth process

(Thompson 1940).

The Marshalls (Majuro) build a birth hut, which can be the ordinary menstruation hut. On the day of confinement men, women, and children gather around the birth hut. The midwife and other female assistants go inside to comfort the woman in labor. In unusual cases, for example if labor is difficult, she calls for her husband, father, or father-in-law to come and support her back. It is strictly forbid den for any other man to go in (Kramer and Nevermann 1938).

Among the Truk most babies are born in the mother's own house, in contrast to the menstrual huts that were also used for childbirth in the past. Only the closest relatives and lineage members of the mother are notified, as the woman is extremely vulnerable to sorcery M (Gladwin and Sarason 1953). Kramer (1932), in contradiction, re lates that all relatives of the man and the woman gather. In addition friends and neighbors of both sexes are there, and even chil

dren are not missing.

Lingenfelter (1971) studied the Yap, who now give birth in hospitals. However, in the past women were sent to "dapal" for 100

days. "Dapal" was a place of initiation, education, menstruation, and used as a hospital for childbirth. Newborn children were kept there for part of their childhood. Children staying at "dapal" learned the facts of birth and of caring for newborns.

The Pukapukans are described by Beaglehole and Beaglehole

(1938, p. 272) as having "extreme realistic attitudes toward child birth." Birth is of interest to the whole community. It has no sense of mystery and is as natural as any other fact of life. Anyone who feels inclined—man, woman or child—has the fullest liberty to be present at birth. Children are fully conversant with all that re lates to childbirth and sex. Parents and children sleep under the same mosquito net and certainly witness sexual intercourse at some time, usually at a very early age. In many conversations children be tween the ages of three and six volunteer detailed accounts of child birth. The children assume that childbirth is as neutral a topic as any other. A favorite game of the younger children is to pretend cohabitation and simulate a pregnancy with a coconut under their clothes. After imitating labor pains, out falls the nut. At an actu

al birth, the long hours of waiting are helped along with gossiping,

laughter and joking, while the children play until late hours of the

night. "Their parents have no objection to their being present at

childbirth—no objection that is, (so) long as they do not insist on

pursuing a kitten between the legs of a parturient woman or hindering

the midwife by tangling her up with a pig that is being chased

(Beaglehole and Beaglehole 1938, p. 292)." The Pukapukans symbolize

the extreme openness of birth in a society within the world area of

Oceania, which contains the largest number of cultural units allowing

children access to birth.

Russia. The major world area of Russia includes two cultural

units, the Gilyak and the Chukchee, with information about access of

childbirth to children. Pilsudski (1910) reports that Gilyak men and

boys must carefully avoid setting foot in the place of confinement.

If the boys encounter a trace of women's blood they would bring on

themselves a crippling disease of the hands and feet. The afflicted

person loses the power to move, gradually wastes away, and finally

dies. The woman in childbirth is not necessarily unclean, but fear

exists that the genital excretions during parturition will give rise to

demons.

The Chukchee woman tends to her own needs and those of the

baby. She cuts the cord and disposes of the placenta. During labor, all men and even small boys leave the room until all the blood is 58 cleaned up. The woman who accepts help will be mocked her whole life long. Even her husband will be nicknamed "the helped one" (Bogoraz-

Tan 1904-09).

South America. The last major world area to be discussed is

South America, which includes 11 cultural units with information re garding access of children to birth. Nine of the cultural units allow children to be present in some way. Two cultural units exclude children from birth.

Cultural units excluding children include the Cuna. Among the

Cuna, birth occurs in a secluded place and not in the hut, to assure that children will not see what is happening. The Cuna believe that God said it is very wrong to teach the small innocent children how birth takes place. Therefore, they are extremely careful about keeping children in ignorance about everything that concerns sex. Older peo ple use circumlocutions when they talk about sex. The baby is born into a canoe filled with sea water, which is placed beneath the hammock in which the mother lies. Children are told that a dolphin has come and left a little child. Other children are told their

"father has been out in the forest where he has seen a deer carrying a little child between his horns. He has overtaken the deer and has taken the child and brought it home (Nordenskiold 1938, p. 370)."

In contrast to the extreme privacy desired by the Cuna, the

Goajira consider childbirth as a natural function that does not need to be hidden. Bolinder (1957, p. 86) reports that birth "often takes place in the presence of the entire household, even of children, and if neighbors arrive, they can be present, too. Even intimate marital acts take place quite openly, to the amazement and embarrassment of a white person." A contradictory account (Gutierrez de Pineda 1950) re ports that children, youth and virgins are not allowed to be present at childbirth among the Goajiro, even though there are regions, such as Jarara, where the woman gives birth in a passageway or under a bough-covered shelter. She is in full view of everyone, even her small children. "There is no concern at all over this matter; childbirth is considered a normal phenomenon and unmarried women may also be present

(Gutierrez de Pineda 1950, p. 131)."

Altschuler (1964) reports about birth at a fiesta among the

Cayapa. The parturient woman is attended by an older woman. A few curious children and some women are the only by-standers. Murra (1948) reports that Cayapa boys and girls begin to help with adult activities when they are very young, and that extremely friendly relations between siblings seem to be the rule. Murra (1948) discusses neither chil dren's activities nor sibling relations in regard to childbirth events.

The Siriono Indians, who live in the tropical rain forest of eastern Bolivia, consider that childbirth is a public event. Child birth normally takes place in a hut, and is well attended by women and children, but rarely by men, who display little interest in birth.

Holraberg (1950) witnessed eight births, all drawing a crowd of women.

The women were standing by or sitting in adjoining hammocks, speculat ing about the birth and gossiping about their own birth experience. 60

"Not a move was made by on-lookers to assist the parturient woman

(Holmberg 1950, p. 67)."

The HRAF reveals contrasting information on two groups of

Araucanians—the Mapuche-Huilliche and the Chile. Titiev (1951) ob serves that young children of the Mapuche-Huilliche are particularly forbidden to approach or touch their mothers during the birthing pro cess. The woman is attended by a midwife or possibly her husband, and occasionally one other man or woman. It is common for all other housemates not assisting to absent themselves as soon as labor begins.

Faron (1961) adds that if the children are present, they will be chased out of the home. The husband also may be asked to leave, unless he helps with a difficult birth.

Hilger (1957) studied the Araucanians of Chile and found that not only are the children allowed to be present at birth, but it is a custom that they should be there, along with the husband, the midwife and the parturient woman's mother. On occasion some of the women's relatives, female friends and neighbors help. They sing during labor, and the midwife pricks all who are present with a needle. The scene of the birth is a curtained-off corner of the house. It is a custom according to Hilger (1957), for all members of a family to stay close to home when anyone is ill. Therefore, because a pregnant woman is considered to be sick, the woman's children are present when she gives birth.

Teachers related instances when a relative or a neighbor of a family requested that children be allowed to leave school and go home because there was sickness in their family. The day following, the children would tell of the birth of a brother or a sister. Informants thought it would be cruel to send the children away from their mother while she is giving birth: "Strangers are not allowed at the birth. But most certainly all the children should be there, now when their mama is sick. She is never away from her family, and why should not all her children be there when she gives birth to one of their brothers or sisters? In any event, the baby is being born in their home. Where should they go?" (Hilger 1957, p. 14).

Another informant, a local father said: "Certainly, the children are

all present at a birth. Where else should they go? They belong in the

same ruka with their mother (Hilger 1957, p. 14)." Another informant

felt that children should be made to appreciate their mothers' suffer

ing: "I have often thought that when children grow up they need to be

told how much their mothers suffered giving them birth (Hilger 1957,

p. 14)." All the boys and girls in a local school were asked if they

had been present at a birth. They all said they were present except

the ones who were too young when a birth occurred to remember it

(Hilger 1957). The Araucanians exemplify the diversity found in cus

toms related to the presence of children at birth. Not only does di

versity exist between major world areas and between cultural units

within world areas, but diversity also exists within specific cultural

units.

Gusinde (1931) studied the Ona, who depend on the assistance

of neighbor women at time of birth. The husband leaves with his sons, usually to go hunting or to stay in a neighboring hut. The small

daughters are also sent away. One informant commented that "a man

should not be present during this process any more than a child should

(Gusinde 1931, p. 523)." 62

Among the Yahgan, all the women, without exception, are atten

tive and sympathetic toward the mother-to-be, and know enough to give

her adequate help, according to Gusinde (1937). Even the young are

adept at lending help at the confinement; however, the very small

girls are sent to women neighbors. Relatives and neighbors regard it

as their duty to help gather food and care for children of the partu

rient woman. The husband leaves the birth scene in their dwelling and

takes his boys, as well as the other male occupants with him. "A feel

ing of tact for the woman in her most difficult hour prohibits male

persons from being present; a sense of modesty advises her to be alone

with a woman helper (Gusinde 1937, p. 497)." Even at night everyone

who is not supposed to be present at the birth leaves the dwelling,

provided there are other huts nearby. If several families occupy a

single hut, the pregnant woman goes quickly to build a small birth hut

(Gusinde 1937).

Barker (1953) observed a birth among the Yanoama. The partu rient woman was in confinement with several other helping women in the woods away from the path and a short distance from the house. Several

persons were watching the birth event, including a couple of men and some children. "They seemed to be only slightly interested, the chil

dren trying to make us go away from there in order to play with them

(Barker 1953, p. 59)."

Among the Bush Negroes, the birthing woman stays in her own hut, and is attended by her mother, her female relatives and friends. Each village has at least one skilled midwife, who is assisted by four

girls from about 10 to 12 years of age (Kahn 1931).

The Puerto Rico of Valle Cana treat childbirth as almost a public affair. Birth, like the rest of the life cycle, including death, is not an isolated occurrence. Landy (1959) concludes that a lack of privacy is not resented, but rather a delight. Likewise peo ple expect to share the experiences of others. However, more and more midwives insist that curious on-lookers stay out, and only the husband or female relatives remain to help. In one case the oldest child woke up during the birth and was simply placed in the corner of the room

(Landy 1959).

In general a Jamaican woman goes to the female head of the household to have the baby, usually to her mother. There is a belief that if the woman is not in the place she wants to be, the birth will be delayed. As many female relatives as possible fit into the room.

The senior member looks after the parturient woman; another keeps the fire and others try to calm any children who may be around. The father stays in the yard with other male friends and relatives (Kerr 1952).

Cohen (1952) writes that the husband supplies the midwife with hot water, and may attend the birth if he desires.

If the birth takes place during the day, children are sent outside to play. If at night, children stay in the house. Some parents send the kids to grandmother or some other rela tive, but that only happens when the home is very crowded. There is nothing wrong with little children witnessing a birth it is said, as they do not have any "sense" to understand what is going on (Cohen 1952, p. 138).

Of the 11 South America cultural units with information about children at birth, nine include children of certain ages at birth in some geographical areas. Two cultural units, the Cuna and the Ona,

seem to explicitly exclude all children from childbirth.

In summary, practices regarding the presence of children at

childbirth have been reviewed for 50 cultural units from six major

world areas. It is apparent that there are 110 universal taboos about

children witnessing childbirth. Neither does a universal explanation

emerge for the inclusion of children at birth. This review is pre

sented as descriptive evidence for the lack of a universal taboo, and

is not meant to generalize about cultural units that include children

at childbirth. What the data can do is suggest the variations in the

ways human beings conceptualize childbirth. Due to the lack of data

for many cultural units, it is impossible to make generalizations ex

plaining the presence or absence of children at childbirth. Little known data exist outside the United States on the child's view of

childbirth, so it is impossible to make cross-cultural comparisons on

this topic at this time. From the information that is available in

the ethnographic literature, it appears that cultural units in Oceania

and South America are the most open to children being present at

birth, and that those in North America are the most closed.

Control of Galton's Problem. A sample of 150 cultural units

from the total number of cultural units has been selected by Murdock

(1981) in order to minimize the effect of common derivation and his torical diffusion, also known as Galton's problem. The 150 cultural units include a total of 25 units from each of six world regions, which are slightly different from the eight HRAF world areas in 65

Table 1. Ethnographic data on access to childbirth by children are available for 38 out of 150 cultural units in the Murdock Sample.

These 38 cultural units are found in Appendix A and are identified by an asterisk. Table 2 reveals 18 cultural units with access to

Table. 2. World regions and accessibility of childbirth to children in the Murdock Sample of 150 cultural units.

World Regions Cultural Units and Accessibility of Childbirth to Children

Information Access to No access Variable available birth to birth practices

Africa 5 1 2 2

Circum-Mediterranean 0 - - -

East Asian 6 3 1 2

Insular Pacific 12 9 1 2

North America 7 1 5 1

Central and South America 8 4 2 2

No Information 112 - - -

Total 150 18 11 9

childbirth by children, and an additional 9 units with variable prac tices depending on location and time. Eleven cultural units in

Murdock's sample of 150 explicitly exclude children. 66

Even if Galton's problem is minimized by the use of Murdock's carefully selected cross-cultural sample, it is apparent that, when ethnographic information about the participation of children at birth, is available, 71 percent of the cultural units allow a certain openness toward the inclusion of children. In conclusion one can proffer that "any practice which any human group has succeeded in institutionalizing and making a part of an ongoing culture expresses a human potentiality (Mead and Newton 1967, p. 144)."

Attitudes toward Children at Birth as Depicted in Games and Art.

In addition to birthing practices regarding location of birth and who is allowed to be present, children's games imply cultural attitudes toward birth. Mead and Newton (1967) have noted that, in some cultures, the games of children reflect the frankness with which birth is regarded. For example, the Pukapukan children play a game where a girl imitates labor pains and then realistically

"gives birth" to a coconut.

In addition to children's games, the approach of some cultures to childbirth is indicated by their portrayal of childbirth in art.

Ploss, Bartels and Bartels (1935), at the turn of the century, collect ed information, art objects, and photographs of various aspects of childbearing around the world throughout time. The few art objects 67 that in some way portray the role of children at childbirth historically are depicted in the following section.

Figure 1 is a terra cotta made by the Bali islanders. It shows a group at a childbi rth scene.

Figure 1. A demon watches the labor of a Balinese woman who is sup ported by a man and a child. (From Ploss, H. H., M. Bartels and P. Bartels. Woman. William Heinemann, London, 1935, vol. 2, p. 630, fig. 711).

The woman in labor is sitting on the ground with her legs straight out. She is supported by a man and a child. A short Malay 68 sword symbolizing masculini~y is stuck behind in the m9n~$ girdle. The man could be a husband or another male helper. He ~uppert~ the woman by pressing her body against him. The figure on the other side

... seems to be a bigger child, and judging by the style of the hair, is probably a boy. The woman has her arm around his shoulders, whilst he has his left arm across her back and with his right hand is touching her right breast. He is crouching down in such a position that the woman's right buttock is be tween his legs and is supported against his abdomen (Ploss et al. 1935, vol. 2, p. 630).

The head of the infant is already born, and the shoulders are about to emerge as depicted in Figure 2.

---=:,1 -:::!.~h ~;, ~ :.~: ~·~: ------~~. ~...~ . ~~· ~==-=· ~

:~ :! . . .

Figure 2. Demon lies in wait for the emerging newborn. (From Ploss, H. H., M. Bartels and P. Bartels. Woman. William Heinemann, London, 1935, vol. 3, p. 46, fig. 801A). 69

The Balinese believe in demons which have a harmful influence on child birth. The terra cotta depicts a crouching demon with gaping mouth down near the woman and baby. With lustful greed the demon is licking its right fore-paw with its long red tongue. "One sees the avidity with which he lies in wait for the child about to be born whose fate ap pears to be decided (Ploss et al. 1935, vol. 2, p. 630)."

Ploss et al. (1935) described obstetric conditions in Peking around 1900, when kin played an important role in childbirth. A few days before the expected beginning of confinement, the female relatives of the pregnant woman gathered in her home. The supervision and con trol appeared to belong to the midwife, and the children had a visiting role, as shown in Figure 3.

She is kneeling on a raised platform, her clothes protect ed by a hand of apron, and is holding the fully dressed newborn in her arms. The wash basin, in which it was cleansed, is still standing beside her. On the same platform the mother is also sitting upright and supported by cushions. Three chil dren, probably the brothers and sisters of the new baby, one still in arms, are visiting the mother; three adult women, one smoking, are also paying their visit. A fourth woman with a closed sunshade is holding one child in her arms. The midwife is represented as an old white-haired matron (Ploss et al. 1935, vol. 2, p. 696).

The traditional birth scene was obviously dominated by females and kin, with children nearby. 70

Figure 3. Family visiting a Chinese lying-in woman, while the midwife holds the child in her arms. (From Ploss, H. H., M. Bartels and Bartels. Woman. William Heinemann, London, 1935, vol. 2, p. 695, fig. 732).

Children are also depicted as playing a role during the lying- in or post-partum period in Europe. Figure A portrays confinement following childbirth in a sixteenth-century German home. 71

Figure 4. German lying-in room of the sixteenth century. (From Ploss, H. H., M. Bartels and P. Bartels. Woman. William Heinemann, London, 1935, vol. 3, p. 146, fig. 845).

The new mother is sitting in bed, supported by pillows. A woman crouch ing in the corner is bathing the newborn child in a big shallow dish.

Behind, her a girl is holding a towel in preparation for the infant. A little girl sitting with a doll in her arms is amusing herself by rock ing the cradle.

Figure 5 shows three children as part of a group of people who are visiting a mother and infant in Holland. 72

Figure 5. Children visiting the mother and infant in Holland. (From Ploss, H. H., M. Bartels and P. Bartels. Woman. William Heinemann, London, 1935, vol. 3, p. 141, fig. 840).

Figure 6. The lying-in woman receives visitors. (From Ploss, H. H., M. Bartels and P. Bartels. Woman. William Heinemann, London, 1935, vol. 3, p. 139 fig. 839). 73

A seventeenth-century German lying-in room is portrayed in

Figure 6. The lying-in woman tried to adorn herself, her newborn babe and the whole room as splendidly as possible, "not only to arouse the admiration of her visitors, but, when possible, also their envy (Ploss et al. 1935, vol. 3, p. 138)." Nevertheless, a child, presumably a sibling, is allowed to play in the lying-in room, near the elaborate cradle.

In summary, a few indicators of the role of children in regard to events surrounding childbearing exist. The simulated-birth game of the Pukapukan children, the portrayal of a Balinese child supporting his mother, and the depiction of Chinese children visiting and European children playing in lying-in rooms are examples of activities of chil dren in relation to childbirth in various cultures throughout time.

Ploss et al. (1935) provide historical documentation regarding access to childbirth in the chapter "Where Birth Takes Place." The following section is based on these early recordings which occasionally mention the role of children at birth.

Historical Documentation

Where birth occurs influences to some extent who is present at birth. The culturally-preferred location for birth varies around the world. Common locations in pre-industrial societies include the home of the parturient woman and husband or the parturient woman's mother; a special enclosure, such as a birth hut or a bath house; or the out- of-doors, such as the woods, bush, seashore or fields, especially if there is a sudden onset of labor. While many people isolate themselves for their delivery, Ploss et al. (1935, vol. 2, p. 562) document that many others had a total lack of concern for privacy: "a confinement to them is a physiological act, at which anyone, even children, may be present, and it usually takes place in the public street."

Examples of historical documentation of parturition in public, with occasional references specifically to children, are found in the following paragraphs. Ploss et al. (1935, vol. 2, p. 563) found that a early as 1625 Purchas recorded that when confinement begins among the

Guinea Negroes "Men, women, youths and children stand around the woman, and she brings her child into the world in most shameless man ner before the eyes of all." Steller (1774) recorded that the

Kamchadale woman was usually delivered lying on her knees in the pres ence of all the people of the village, without distinction of sex and position.

Women in New Zealand were delivered in the open air before a group of persons of both sexes. The bystanders watched with attention for the moment when the child came into the world (Rienzi 1839).

Parturition in the Hawaiian islands was also a public act, at which anyone who happened to be about looked on.

Children were often present at birth in the Dutch East Indies, according to Van der Burg (1884). Also in the Kei islands, when a birth was taking place, the house was open to all.

Among the Munda in Chota Nagpur, India, during labor and birth the woman's own children as well as other children of any age remained in the room till the baby was born. Jellinghouse (1871, p.

366) commented that "this barbarous naturalness (as it appears to us) seems not to have any bad influence on the morals of the children."

In Central Africa, Felkin (1884) found many onlookers at delivery in several Negro tribes, but the presence of children was not toler ated.

In conclusion, even though the documentation is sparse, the historical evidence reveals that a universal taboo against children being present at childbirth has not existed at least for several centuries. The diversity in cultural priorities regarding accessibil ity of childbirth to children challenges dogmatism as well as a rigid adherence to the inclusion or exclusion of any person based on sex or ag. . Indeed, any practice made part of an ongoing culture expresses human potentiality.

Summary

As frequently occurs with cross-cultural studies and compari sons, this review shatters

...facile generalizations about children, about what the child perceives, knows, and feels... .Wemust stop assuming that what we see, or think we see, in the children of our society at this time necessarily tells us what is universal or inevi table. Each supposed "universal" must be subjected to the cross-cultural test.

It fails the test if it does not hold true in even one society. And if it is not a universal it is not inevitable; the behavior in question can be changed (Goodman 1970, p. 157).

A cross-cultural review of the accessibility of childbirth to children, has been presented in this chapter. Twenty cultural units 76 allow access of childbirth to children, and an additional twelve cul tural units include some children at some time. Eighteen cultural units do not allow children to be present at birth. This information does not necessarily mean that the cultural arrangements affecting children during childbirth are of equal quality or implicit appropriate ness. It documents the variation of cultural patterning of the uni versal event of childbirth and the role played by children throughout time and space. CHAPTER 4

THE GUIDING PERSPECTIVES

The concepts of childbirth as a sociocultural event, the cul ture of childhood, child's-eye view and cognitive development serve as the guiding perspectives to this study. These concepts, as they relate to the study, are discussed in this chapter.

Childbirth as a Sociocultural Event

Childbirth is conceptualized as a significant life-cycle event that is socially organized and culturally shaped. In no known society is childbirth treated as a mere physiological function, al though until recently researchers have attended primarily to the physiological and pathological aspects. The birth event is defined as the occurrence of labor, delivery, and the postpartum period, includ ing the social-interactional and the social-ecological aspects (Jordan

1980).

The focus in this study is on the sociocultural context of childbearing, which denotes a shift in conceptual orientation away from strict concern on the physiological process and the outcome of the product. Browner (1982, p. 6) explains the shift in orientation:

When mostly male psychiatrists, psychologists, and physi cians looked at pregnancy and childbirth, they sought to dis cover why women "failed" at their biologically-given roles,

77 and to understand how these failures could be avoided. Now that more childbirth investigators are female, their atten tions have turned to examining the structural factors which have made childbearing an unhappy experience for many women.

Researchers, spurred on by consumers, are now concerned not

only with success or failure of the outcome, but also with the quality

of the whole experience of pregnancy and birth.

Nevertheless, in the United States birth is overwhelmingly

seen as a medical event, and, according to Jordan (1980, p. 34), "a

society's way of conceptualizing birth constitutes the single most

powerful indicator of the general shape of its birthing system." So

ciety's concept of birth is operationalized in specific birthing

practices, such as accepted locations for childbirth and accessibility

of childbirth to family members and others. Mead and Newton (1967)

believe childbearing both reflects and supports the larger sociocul-

tural system. If birth is conceptualized as an illness requiring the

"privacy" of a hospital and the attention of specialists, children are

likely to be excluded, as well as all other non-specialists. Only re

cently have fathers been allowed to be present when a baby is born.

Accessibility or lack of accessibility of childbirth to family

members may have specific adaptive values in various cultures. Ford

(1964) reasons that natural selection is operating in the limitations

of numbers of persons allowed to be present at childbirth. Each person

is viewed as a potential source of infection. By decreasing the number

of people attending birth and thereby decreasing the chances of con

tamination, the cultural pattern is adaptive. Even though there is not a universal taboo against the presence of children at birth, a strong taboo exists in many societies. Adaptation is a possible explanation for the origin and persistence of this taboo in many cultures.

In the United States some parents are consciously deciding to break this taboo which forbids the presence of children at child birth. The consequences of this sociocultural change in the birthing system have not been charted. As with other particular features of childbearing systems, the specific practice of including children at birth also is culturally determined and socially organized. Therefore, the practice of including siblings at birth is viewed within the con text of the basic unit of American social organization, the family. A family is defined as "a unit of interacting persons whose central ob jective is to create and maintain a common culture and to promote the physical, mental, and social development of each member (Clark and

Affonso 1976, p. 239)."

According to Linton (1936), the family, the smallest social unit, primarily determines the exposure of its members to specific experiences such as childbirth. The common cultural experience of the family provides a specific influence, but with infinite cultural dif ferences. For example, attitudes between parent and child and the rights and responsibilities of children in the family structure vary greatly from one culture to another, including the role of children in relation to childbirth and childrearing.

Howells (1972) describes childbirth as an experience which be longs to the family as a whole. He recommends a family approach to 80 birth which includes preparation for all family members, and a home or hospital birth with full family participation. A family approach does not necessarily imply that all family members share every aspect of the birth.

Enkin (1975), an obstetrician, was one of the first to suggest specifically that children be allowed to participate by being present at the birth of their sibling. He framed his questions about the in clusion of children within the larger context of the family unit:

What about literally bringing the whole family in for labor? Is the idea really any more preposterous than the idea of bringing the father into delivery seemed 15 years ago? There is much evidence that family attachment and close ness might be greatly enhanced by increasing sibling in volvement in childbirth... .Why should [siblings] not be present for the labor and birth as well? To be sure, our deliv ery rooms are awfully small. Still, we manage to crowd in, at times, the father, an obstetrician, a family doc tor, a resident, an intern, a medical student or two, maybe an anesthetist, couple of nurses, a pediatrician— oh yes, I nearly forgot—the mother and new baby. We could probably squeeze in a small brother or sister and hardly notice the difference. Would it be psychologi cally damaging to that brother .or sister to see the turmoil and the blood and stress and strain of child birth? Would he or she faint, cry, or run, or get in the way, or contaminate our sterile field? I don't know. I don't know any one who does know. But I do know that they raised all these fears about the participation of fathers in labor and delivery, and that is now ancient history (Enkin 1975, p. 133).

As specific birthing practices change, it is crucial to seek answers to incipient questions. McClain (1982) believes such re search efforts are important to understanding childbirth as a cul tural system. Resulting knowledge of culturally-determined patterns of specific concepts, such as illness, health, healing, birth and 81

death can then be applied by health professionals in the context of

maternal, child and family health.

Culture of Childhood

In his 1763 classic work Emile, Rousseau wrote: "Childhood has

its own way of seeing, thinking, and feeling, and nothing is more fool

ish than to try to substitute ours for theirs (Elkind 1981, p. 3)."

Aries (1962) has noted that throughout history childhood has been view

ed as a "subculture," at times inhabited by savages, miniature adults,

or mythical and magical beings. However, the views of children have

seldom been systematically explored, and this neglect has left wide

gaps in knowledge about children's concepts of birth and death.

For the purpose of this study, the culture of childhood is de

fined as "the manner in which children in different societies see them

selves and are seen by adults; the values and attitudes that children

take from others or discover for themselves (Goodman 1970, p. xi)."

Children have a unique point of view which they generate out of their

own personal, social and cultural material.

Like all cultures, the culture of childhood is learned, shared,

and transmitted. "Concepts about adults—their marital relationships,

their work, and other aspects of their lives are built into the cul

ture of childhood as children watch, listen and speculate (Goodman 1970,

p. 94)." According to Aamodt (1971, p. 266), "What a child has to say

may mirror the beliefs, values, and attitudes of the adult group he lives with. At times, on the other hand, it emphasizes content that 82 belongs only to the world of the child and appears distorted and re arranged when viewed from an adult perspective." Thus, children learn to respond to situations, such as childbirth, in the same or similar manner that their parents respond, or, at times, from a unique chil dren's view.

Goodman's (1970) approach to the culture of childhood is cogni tive in orientation, that is, it excludes behavior and restricts the culture concept primarily to values, attitudes, and knowledge.

Goodenough (1957, p. 167) also emphasizes the cognitive aspect of cul ture: "Culture is not a material phenomenon; it does not consist of things, people, behavior, or emotions. It is rather an organization of these things. It is the forms of things that people have in mind, their models for perceiving, relating, and otherwise interpreting them."

In contrast to Goodman and Goodenough, other anthropologists prefer a behavioral definition of culture. For example, Harris (1968, p. 16) states that "the culture concept comes down to behavior patterns associated with particular groups of peoples, that is to 'customs', or to a people's 'way of life.'" Spradley (1979, p. 5) prefers to con sider both cultural behavior and cultural knowledge, which he combines into the following definition of culture: "... acquired knowledge that people use to interpret experience and generate social behavior." Cul tural behavior is analogous to the top of an iceberg. Beneath the sur face, out of sight, is the vast portion of cultural knowledge.

Culture of childhood studies in the Goodman (1970) style report on what children see as they observe the world in which they find themselves, and specific events with which they become involved. For example, Goodman (1962) studied four-and five-year-olds in America and Japan. She noted the keen perception and sharp logic they brought to bear on the social scene, for instance, taking note of peo ple, things, and behavior, and arriving at, or trying out, classifica tions on the basis of their perceptions. In contrast, most studies in the enormous body of literature on child development and childrearing

"report what adults see when they observe children, and what adults do for and to children (Goodman 1970, p. 2)." DiLeo (1977, p. viii) be lieves that "the child who is known only through adults is known wrong."

The present study was based on the following assumptions about the culture of childhood: (1) children have their own ideas about birth which are based in the culture of childhood; (2) children's con cepts of birth continually alter with progression in experience and cognitive ability; (3) cultural knowledge can be learned through obser vation of behavior and verbal and drawing expressions of children; and

(4) children's views of birth are culturally influenced by significant people in the children's life, as well as by society as a whole. In spite of a cultural pull, however, individual differences are never obliterated.

Child's-Eye View

The child's-eye view refers to what the child sees and to the meaning attached to the perceptions (Goodman 1970). The child viewer is defined "as one who perceives his social scene and selects and rejects, consciously and unconsciously, from alternatives provided [within the] culturally constituted environment (Aamodt 1971, p. 5)."

This study uses an emic approach to discover the child's-eye view, that is, what children describe they see when they observe the world, rather than what adults see when they observe children. Accord ing to Pelto and Pelto (1978, p. 62), the intent with the emic approach is to "seek the categories of meanings, as nearly as possible in the ways 'the natives define things,'" In this study, I searched for the meaning children ascribe to culturally influenced events surrounding childbirth.

As children perceive their sociocultural scene and integrate their perceptions with their world view, they generate cognitive pat terns that are, in some ways, uniquely their own. These cognitive patterns are both similar to and different from those of their peers, family and society (Aamodt 1971). Perception is a cognitive process through which environmental stimuli are interpreted and meaning is attached. The process of perception is goal-oriented in that a stim ulus will not be attended to unless it has some meaning for the indi vidual (Spradley 1972). The meaning of the experienced events shapes the view of the world and specific objects or events within it (Knutson

1970). Selected stimuli are categorized in the brain to form concepts.

Meaning is attached to the concepts through the use of symbols, which can then be utilized to synthesize new knowledge. Culturally deter mined patterns of conceptualization in the growing child capture 85

attention of anthropologists interested in the differences and similar

ities in the ideological worlds of children and adults, and health

professionals are specifically interested in conceptualization of

health-related events.

Piaget (1973) maintains that the child's conception of the

world is built in the process of cognitive development and that the

meaning of specific concepts is learned. Therefore, the child's con

ception of birth depends, to some extent on the level of cognitive de

velopment, and alters with progression in experience and cognitive

ability.

Fragner (1979) agrees with Piaget about the significance of

child's cognitive level in interpreting events. She specifically dis

cusses the importance of the child's interpretation of the birth ex

perience, rather than the nature of the potentially threatening event

itself:

This interpretation will depend upon several factors: the child's cognitive level, previous coping skills, and experi ence and confidence in dealing with new and unfamiliar situa tions. The interpretation of the birth will also be influenced by the child's existing attitudinal set, which is based upon, past experiences of the world, and by the atti tudes and feelings of others present at the birth. It is clear that every element of human behavior or experience has. more than one meaning. However, children will bring to the birth experience their own context, which is the result of their developing attitudes about the world, based upon previ ous experience. This existing pattern will color any inter pretation of the birth, and its importance in examining the birth experience itself should not be minimized (Fragner 1979, pp. 180-81).

As maturation and experience alter the child's view, so will the perception of certain events, for example, stressful events such as birth and death. O'Neil and Kapp (1977) believe events may or may not be stressful for adults and children alike. Children do not learn, think or feel in the same way as adults (Elkind 1981). The differences between, children and adults have been documented in studies about children's conceptualization of death.

Knowledge of how children understand death differently at vari ous ages has helped health professionals work with children who have a terminal illness and, in some cases, have died. It is realistic to think that adults could better help the child integrate the concept of death (or birth) into their lives if adults knew the child's view and how much the child could cognitively understand (Perrin and Gerrity

1981).

Likewise, knowing children's views of childbirth helps health professionals who seek to provide anticipatory guidance to childbearing families, and to facilitate the participation of children at birthing events in those cases where families choose to include siblings.

Learning what children are thinking helps adults make sure the foun dation for understanding is sound before going on to build elaborate explanations (Bernstein 1978). The way in which a child learns about and understands birth may have far-reaching implications for later attitudes toward childbearing, family, male and female roles, and sib ling relationships.

In conclusion, because children interpret experiences dif ferently from adults, it is essential to study children's views, "to stand with them and look with them out upon the social scene

(Goodman 1952, p. 137)." The ethnographic approach can be used to learn the child's view by focusing on the meaning of actions

and events to children of various ages and levels of cognitive

development.

Cognitive Development

At each stage of development, children have a characteristic way of viewing the world and explaining it to themselves. This study describes the way six-to twelve-year-olds view childbirth. Piaget's staging of cognitive development into age groups is used to guide the selection of informants because cognitive development is recog nized as an important influencing factor. Six-to twelve-year-olds represent an age group which is similar in cognitive development.

According to Piaget's framework of intellectual development, children's thinking progresses through discrete stages characterized by qualitatively different cognitive structures. In order to best understand the evolution of children's conceptions of life and death,

Elkind and Weiner (1978, p. 328) recommend approaching the process in the "context of general systems of thought that characterize intelli gence at different age levels. For this purpose, the general stages of intellectual development described by Piaget are appropriate."

The basic idea in Piaget's theory of cognitive development is that old structures are fitted (assimilated) to new functions, and new structures accommodate old functions under changed circumstances. 88

Adaptation, the cognitive striving of individuals to find an equilibri um between themselves and the environment, depends on assimilation and accommodation as the child attempts to meet the demands of reality and to find consistency among ideas (Maier 1969, Beard 1969).

Children adapt, based on their level of cognitive development, and intellectual growth occurs as children adapt to new situations.

Elkind and Weiner (1978, p. 244) explain the process: "The young child has a full conceptual world as rich as but different from adults. At each stage the child constructs his or her conceptual world. Part of growing up is learning about the conceptual world of adults and grad ually giving up the conceptual world of early childhood,"

Piaget regards each child as a philosopher who strives at mak ing the world understandable. Children use all resources at their disposal—"what they themselves perceive with their senses, the infor mation given them by others, and their own style of putting the puz zle together (Bernstein 1978, p. 4)."

Piaget believes that maturation of the muscular and nervous systems play a role in development, but that the environmental effect is also important. Piaget maintains that from birth, the child actively seeks contact with the environment and looks for new levels of stimu lation. "When an event occurs it is interpreted and assigned meaning by the child (Bernstein 1978, p. 4)."

According to Shweder (1982, p. 357), the Piagetian idea that children's mental structures characteristically fit into certain stages 89 is under attack by cognitive developmental psychologists, who are

"about to abandon the notion of broad stages in thinking, (and) about to acknowledge that many operational structures, previously thought to be absent, are in fact available to the mind of the preliterate, preschool Western child...." When cognitive functioning of individ uals across a series of tasks is examined, no single operational level emerges as the general property of an individual's thought.

Shweder (1982) cites approximately 25 studies which conclude that cognitive functioning is not independent of the details of the task. For example, Lempers, Flavell, and Flavell (1977) found two-year- olds capable of taking the perspective of another, not in the usual way of asking the two-year-olds to coordinate a conversation over the tele phone, but by investigating whether two-year-olds consider the visual perspective of others when showing pictures to observers.

Shatz and Gelman (1973) also searched for a distinction be tween the perspective of self and the perspective of others, which they detected by observing speech patterns of four-year-olds. They found the children took into account the ages of the listener when telling a two- year-old, a peer, or an adult about a toy. Shweder (1982, p. 358) con cludes that "the failure of a child (or an adult) to display this or that mode of thought on this or that task is no indication that the mode of thought is unavailable...." Cole and Scribner (1974) have ad vocated this point of view for several years.

It seems possible that most people (children and adults) have most operational mental structures, and that the application of mental 90 structure depends on the content and features of the task. In spite of the challenge to Piaget's theory, the theory continues to be used as the basis for staging cognitive development in several disciplines.

Piaget remains the most influential theorist in the cognitive area since the 1960s.

Elkind (1970) and Furth and Wachs (1974) have validated much of Piaget's framework. A major contribution of Piaget and research based on his theory has been to create an awareness that children at every stage of development actively construct the world in order to understand it and cope with it (Perrin and Gerrity 1981). For example,

Lonetto (1980) guided by a Piagetian framework, used a phenomenological approach to describe children's views of death through their words and drawings. He concluded that children's conceptions about death seem to develop in a similar fashion to their conceptions in other areas: they begin with a lack of any"concept, move gradually to incomplete under standing, and then on to adultlike comprehension. "The development of children's conceptions of death is part of their total cognitive de velopment and is not simply a function of their age.... The relation ship between cognitive and chronological development is yet to be defined precisely (Lonetto 1980, p. 3)."

Cognitive development and children's conceptualization of death have interested researchers for decades, in contrast to the recent interest in conceptualization of birth. One of the early and most fa mous investigations was done in Hungary by Nagy (1948). Children ranging from three to ten years of age were studied. Data were collected through (1) written compositions on everything coming to mind about death; (2) drawing pictures about death and explaining them; and (3) interviews about death and dying. Three stages of development were found: (1) denial of death as a final process in three-to five-year- olds; (2) personification of death in five-to nine-year-olds; and (3) beginning awareness of death as an internal process that is inevitable, permanent and irreversible in nine-year-olds (Nagy 1948). Rochlin

(1959) corroborated Nagy's findings with three-to five-year-old Ameri can children.

Rank (1967) observed that American children are often assumed to be unable to comprehend or accept the idea of death because of its painfulness or unpleasantness. However, observations by Anthony (1967) showed that often children do not share the adults' distress concerning the thoughts of death.

In the 1970s several researchers studied the concepts of inevitability, reversibility, and differences between life and death states, some using a Piagetian framework (Childers and Wimmer 1971,

Hansen 1972, Formanek 1974, Koocher 1974, Weininger 1982). In general, their findings have been similar: (1) preoperational children (3 to 6 years) saw death as a nonpermanent reversible state and used fantasy reasoning; (2) concrete operational children (7 to 12 years) saw spe cific means of inflicting death and in some studies grasped death as permanent and inevitable; and (3) formal operational children (over 12 years) recognized physical deterioration and death as a physical process. 92

The present study describes children's views of the opposite end of the life cycle, birth. This study is not designed to "stage" chil dren's concepts of birth or to test Piaget'stheory, but rather to describe the view of childbirth of a cognitively similar age group, namely six-to twelve-year-old children.

The concepts described in this chapter include: (1) child birth as a sociocultural event; (2) culture of childhood; (3) child's- eye view; and (4) cognitive development. These concepts have served as the guiding perspectives to this descriptive ethnographic study of the meaning of the sociocultural event of childbirth to six-to twelve- year-olds, an age range which includes children from a similar stage of cognitive development. The child's-eye view is influenced by that of parents and other adults, and is also unique to the culture of childhood. CHAPTER 5

METHDOLOGY: THE ETHNOGRAPHIC APPROACH

This study, using a qualitative approach, attempts to discover

the meaning of birth to six-to twelve-year-old children. Qualitative

research is suited to discover meaning of sociocultural events to indi

viduals. Birth and death are examples of sociocultural events of

great significance that bring health professionals together with cli

ents and families. Therefore, the use of qualitative research is

appropriate to discover the meaning of birth to children, and thereby

answer the research questions regarding children's views of childbirth.

Children's views of birth were elicited through drawings and

ethnographic interviews, strategies according to Spradley (1979, p. 9)

"for getting people to talk about what they know." The interviews were

transcribed, analyzed and organized into meaningful categories, which

represent the knowledge used by children to interpret birth. This study

was not intended to be an ethnography, but rather a description of

children's views of a particular event.

One requirement of qualitative research is that the researcher

becomes immersed in the data. Because of this immersion process, it is

important to communicate not only about the research method, setting and subjects, but also to provide information about the researcher conducting the study. This chapter on methodology presents information on the re searcher, the informants, and the research design.

93 94

The Researcher

The issue of children at birth came to my attention in a per

sonal way. My three-year-old son witnessed the birth of his sister in

197 7. He was intentionally included at the birth because of my belief

that childbirth is an important event to be shared by all family members.

A short time later, the local pediatric society heatedly debated

the issue of children's presence at childbirth. One child psychologist maintained it was permanently and psychically damaging to submit a child

to the trauma of observing a birth. A pediatrician believed that a uni versal taboo existed, that is, that no society in the world allowed children to be present. Another pediatrician recalled his own obstetri cal experience in medical school attending laboring women in "twilight sleep." He concluded that seeing women in labor, medicated with scopolamine and thrashing around in a bed with raised siderails, was not an appropriate experience for a child (nor for a laboring woman, I might add).

Later another pediatrician commented: "It could scare the day lights out of a kid. And preparing a child for what he would see dur ing the birth would not make a difference. You can't prepare a six year old. Hell, they don't know what's going on (Stengel 1979, p. CI)."

I concluded that much emotional fervor and many staunchly-held personal beliefs existed on the topic of children's presence at childbirth, but that most opinions were based on adults' fearful view of complicated hospitalized births.

Indeed, letters printed in the newspaper column "Dear Abby", indicated that many opinions about children being present at birth are based on adult "assumptions" that birth is painful, dangerous, fright ening, unpleasant, private, mysterious, dirty, and obscene (The Arizona

Daily Star 1980). A grandmother wrote that her daughter planned to have natural childbirth with the daughter's husband and three-year-old son present at the birth. This plan was contrary to the conservative modest background of the grandmother. Abby refused to be shocked, but suggest ed that witnessing childbirth might be the best way to learn about the miracle of life. That amazing answer brought a deluge of responses from readers across the country. The letters at one point were running one hundred to one against her answer. Readers cynically suggested inviting little league teams and nursery school classes. One suggested it was child abuse. Several obstetrical nurses reacted strongly. One nurse revealed her feelings that not only was there no need for hysterical kids, but also that hospital staffs could do without fainting fathers.

There were some positive responses from convinced parents who indicated that presence at birth would help children be unafraid later, and would help them grow up respecting the miracle of birth.

I was aware of positive anecdotes from parents regarding the par ticipation of children at births, mostly home births. I realized such stories and opinions conflicted with the position of many health profes sionals, but parents held their beliefs with equal fervor. As a commu nity health nursing instructor and a community resource person for information on alternative health care for childbearing families, I no ticed concern, confusion, and even hostility between parents and health professionals regarding the question: "What about children at birth?" 96

Seeking an answer, I turned to the professional literature and

found a void on the subject of the presence of children at childbirth.

This motivated me to design an exploratory comparative study. The pur

pose of the study was to learn about the responses of siblings, as per

ceived by the parents, to pregnancy, birth, and the newborn. The pilot

study, described in Chapter 2, yielded data on children's reactions to

birth—through the eyes of parents. It became clear that if I wanted to

understand how children themselves perceive and interpret childbirth, I

needed to go directly to the source and interview the children and col

lect drawings. In the second study, an open-ended questionnaire was

used to guide the interviews with the children. These findings have also

been described in Chapter 2. Both of these studies supported my hunch

that children have their own ideas about birth, as they do about sexuali

ty, death and other significant events. Their ideas may be vague and

continually changing as they grow older, acquire more experience and more

exposure to the adult world, but their ideas are in some ways unique to

childhood.

When I entered the doctoral program at the University of Arizona

College of Nursing, I selected children and childbirth as my research

area. I was interested in the application of existing knowledge about

children and childbearing to the question: "What about children at

birth?" I was also interested in identifying significant variables con

cerning preparation and participation of children that could eventually

lead to testing variables that would explain and predict children's be

havior at birth, and to theory development on this topic. Newman's

(1979, p. 43) writings about theory development encouraged 97

me: "...a good place to start is by your vague discontent, that

phenomenon that 'bugs' you, that you want an explanation for: your

concept of concern."

My personal curiosity and professional interest in the topic of children witnessing birth determines my "concept of concern.", On one hand I believe personal involvement is one of the necessary forces that sustains a researcher through a research project; however, on the other hand, research driven by personal investment can be contaminated by bias, subjectivity, and preformed notions. In qualitative re search the researcher has an important impact on the findings due to the intentions of involving oneself in a cultural scene, that is, an every day social situation shared with some individuals but not others.

Ideally the cultural scene is unfamiliar to the researcher. Familiarity can cause the ethnographer to take things for granted and be dulled to slight variation.

Another danger that accompanies qualitative research on a sub ject of personal interest is referred to as the "bias of romanticism," that is seeing and/or reporting only the functionally adaptive or positive aspects of the lives of informants (Rohner 1980). My aware ness of potential biases served as a constant reminder not to skim over "negative" reports from children regarding their views of birth.

At one point a dissertation committee member needed to prod me toward attending to the "positive" comments from children. In my fear of succumbing to the "bias of romanticism," I had overcompensated for my own preformed positive notions regarding children and childbirth. 98

My purpose and approach were geared to seeking the child's-eye

view from 14 school age informants. Nevertheless, the data presented

in Chapter 6 represent my view of the child's view of birth. The

informants are described in the following section.

The Informants

This section describes the use of children as informants

in terms of cognitive and language development, and the use of children's drawings as ethnographic data. The process of finding

the specific informants for this study and negotiating entry into

their families is also presented.

Children as Informants

Selltiz, Wrightman and Cook (1959, p. 236) suggest that "if we want to know how people feel, what they experience and what they remem ber, what their emotions and motives are like, and the reasons for acting as they do, why not ask them?" This also applies to children.

Goodman (1952) found that children are good informants, and, by virtue of their membership in society are as qualified to be informants as adults.

Spradley (1979) believes that children usually make good infor mants because they have adequate free time and are eager to talk. In addition to availability, he suggests a good informant have the follow ing characteristics: (1) be thoroughly enculturated in order to talk about the topic in detail and almost without thinking about it; (2) have current first-hand involvement in the cultural scene; and (3) be nonanalytic, that is be able to describe events with little analysis of

their meaning or significance. Children are especially able to meet

the criterion regarding a nonanalytic nature. The familiarity of chil

dren with a cultural scene might be somewhat limited due to restricted

opportunity for involvement, especially regarding the cultural scene

of childbirth.

School age children between the ages of six and twelve make

good informants because of their level of cognitive and language devel

opment. In order to understand the child1s views, it is helpful to put

them in the context of general systems of thought that characterize the school age child, such as those described by Piaget. Children between

the ages of six or seven to eleven years begin to reason and think logically, that is, their perceptions are subject to logical processes.

Piagetians refer to this period as the concrete operational stage of cognitive development. Children in this stage are forced to hold their solutions up to the measure of experience and opinion. Left to their devices, they would believe their own ideas to be the sum total of re ality. During the school age years children learn to differentiate between fantasy and reality. It is at this stage that certain concepts of inevitability, such as death, birth and sex differences become established (Lewis 1982).

Bernstein (1978) looks specifically at stages of cognitive development related to children's perception of origin of babies. She describes the five to ten year olds as "in-betweens," bordered by the four to eight year old "manufacturers" and the seven to twelve year 100 old "reporters." The four to eight year olds do not believe babies have always existed as the younger pre-schoolers do, but rather that babies must be manufactured limb by limb. The "reporters" are concerned about accuracy and are hesitant to guess about the orgin of babies. They accept facts on the strength of authority, such as parents, teachers and books.

The "in-betweens" are in a transition period between pre operational and concrete operational. During this time, children are often aware that their explanations of the origin of babies don't quite add up. As they become more aware of the adult criterion of "making sense," they become self-conscious and no longer answer freely, but may show embarrassment and refuse to answer. Bernstein (1978) has noted that the "in-betweens" are the ones likely to use malapropisms, such as

"sperm" for embryo, and "deforming" for developing.

New mental abilities allow school age children to do in their heads what they previously had to do with their hands. They can manip ulate symbols, not just objects, which extends the range and variety of explorations children can perform (Elkind.1981). They have the ability to organize and classify things that have been experienced or seen.

Eventually logic depends on thought rather than on perception alone. As children gradually become less dependent on their perceptual fields, they are able to classify on the basis of general, less con crete aspects, and in a hierarchical way. For example, an apple will be thought of as a fruit rather than as something one eats (DiLeo 1977).

School age children use inductive logic to move from the particular to 101

the general. These characteristics are necessary for informants to be

able to organize and classify information, essential skills for using

various ethnographic techniques.

Rather than being bound to irreversibility as in the pre

operational period, the school age child begins to be able to reverse

mental operations and return to the starting point. Comparisons, re

lations, inclusions, ordering and measurement of concrete objects are

within their ability (Bernstein 1978). With varying degrees of

sophistication, children can engage in problem-solving requiring plan

ning, relating, classifying and drawing conclusions (Weininger 1982).

School age children have the capacity to learn and operate

according to rules, and thus are intellectually capable of learning

the culture of childhood, which is, in effect, a body of rules belong

ing to an age group who share a common way of looking at and dealing

with the world. School age children also share universal fantasies,

fears, unhappiness and anger (Elkind and Weiner 1978).

School age children are less egocentric than pre-schoolers,

but whether or not they can assume the perspective of another is

debatable. According to Bernstein (1978), the same obstacles that

prevent children from adapting themselves to other people's points of

view are at work to prevent their using the evidence of their own

senses to construct a coherent world view. Between five and ten years,

children move back and forth from their egocentric world to the social world of shared perceptions, and begin to take into account another

person's point of view. 102

In general, language development parallels cognitive develop

ment, moving from the concrete toward the abstract, however, children

cannot think about their own thinking, which is too abstract at this

stage. Between five and ten there is considerable growth in vocabu

lary and syntactic understanding of language. Children learn to use

many new terms. According to Elkind and Weiner (1978), concrete

operations are closely linked to the spontaneous use of comparatives

rather than absolutes in verbal description. School age children de

velop a new understanding of more, less and the same. Younger children

understand comparatives in things they see, but school age children

understand nonperceptual differences. They can also express ideas and

emotional attitudes.

Interviewing informants who are at the concrete operational

level of cognitive and language development makes it possible to use a variety of ethnographic techniques to learn the child's-eye view. Such children can verbally express their ideas, perceptions, and emotions in a logical reality-oriented fashion. They can learn and follow rules, organize, classify and compare.

The use of children's drawings is also a technique that has been used to establish the child's view. Machover (1953) advocated the use of drawings to learn about children for several reasons: they are a pleasurable form of communication; they relieve tension; they have relatively simple instructions; and a skillful performance is not a necessity. 103

Schuster (1971) found six-to twelve-year-olds to be particular ly receptive and capable of responding to the demands of drawing. At an earlier age, the imagery is too amorphous. Younger children lack the motor control to convey their perceptions. Later, with the onset of adolescent self-criticism, self-consciousness, and preoccupation with normative social values, the drawings often lose their unconscious perceptual value.

Around seven years of age children begin to create symbolic representations of mental images. Fine-motor control is sufficiently developed to enable the production of recognizable orderly pictures.

The ability to maintain order in spatial relationships is due to logical thinking, refined fine-motor control, and improved perceptual skill (McLeavey 1979).

Coles (1964, 1977a, 1977b) used children as informants in his investigations of the contribution of childrearing and family patterning to the development of children's perceptions of their world.

Children's verbalizations and drawings were used to collect information.

Goodman (1962) proposed the use of drawings as a method of securing the child's eye view.

Aamodt (1971), in addition to collecting ethnographic state ments and making participant observations, asked Papago Indian chil dren to draw pictures and tell stories about the pictures in order to learn their views of health and illness. Drawings have significance for children because they represent their subjective perceptions of the so-called objective world. 104

Lonetto (1980) used drawings to study children's conceptions of death, and found that children do not necessarily draw all that they know, but rather limit drawings to those symbolic groupings of impor tance at the time. Lonetto (1980, p. 47) noted that "the child's draw ings are a type of cognitive mapping of his world, an insight for others to share in." Children usually included in their drawings things that had meaning to them, that they found important, interesting, pleasurable, fearful, and so on.

Goodnow (1977, p. 2) studied children's drawings because they are

...indications of more general phenomena of human life. They may be regarded as expressions of our search for order in a complex world, as examples of communication, as indices of the type of society we live in, as signs of intellectural de velopment, as reminders of our own lost innocence and verve... they are "natural" rather than imitative...they spring from within. If this is correct, then if we can understand them better we will have a better understanding of children and de velopment in general.

Children's drawings have been used in various types of analysis of children's thoughts, attitudes and values. Elkisch (1960) found analysis of free art expression useful in making psychological diagno ses. Gellert (1968) used a draw-a-person task to study children's awareness of their own bodily attributes. Miles (1972) used children's drawings to establish their understanding of their own conception and birth.

DiLeo (1973) has discussed children's art with emphasis on de velopment and deviant characteristics, and on the use of drawings as diagnostic aids. The validity of human figure drawings as an indicator 105

of intellectual maturity has been demonstrated by investigators who re

ported statistically significant correlations with the Stanford-Benet

and Wechsler Intelligence Scale of Children. When drawings have been

viewed as projections of personality, the same degree of agreement has

not been achieved.

Burns and Kaufman (1970) and Burns (1982) found kinetic family

drawings (K-F-D), that is, everyone in the family.doing something, more informative than the traditional children's human figure drawings of their families. The rationale behind the K-F-D test is that chil dren's responses show how they feel about themselves as family members often better than words.

Kellogg (1979) collected more than a million children's draw ings from many countries between 1948 and 1970. She became skeptical of psychologists' claims of diagnosing children's emotional problems on the basis of several drawings and cautioned adults not to assume that what they see is what the child sees.

McLeavey (1979), a nurse practitioner, used children's art as a preliminary screening tool in the physical assessment of children. A drawing, easily obtained, could suggest the presence of a developmental lag or a possible emotional problem. She concluded that indicators of potential emotional problems or existing conflicts are more subtle than the age-specific developmental characteristics of children's drawings.

She attempted to analyze the drawings using a checklist based on the literature to correlate elements of the drawing with specific emotion al problems, for example, shading indicates anxiety and tiny feet signal insecurity. McLeavey (1979) found vagueness and contradiction 106 in the literature. Some authors interpret large, out-stretched arms to mean aggression, while others believe the same element in a drawing indicates a welcome feeling.

I cannot stress too strongly that even though the litera ture provides cues or signals for potential problems, my major, source of information regarding the child's emotional status is what he or she verbally relates to me while describ ing the drawing. Thus, the purpose of the drawing is primar ily to open pathways of communication with the child. The child describes verbally what he has drawn symbolically (McLeavey 1979, p. 14).

Children1 s drawings, as described by the children, were deemed an appropriate technique for seeking the child1s-eye view about birth from the informants. In summary, six-to twelve-year-olds were selected as informants because of their abilities to verbalize, to think logically, to order ideas, to classify, and to draw and describe recognizable pic tures.

Study Informants

My original intention was to interview children and collect drawings before and after the birth, and to directly observe children at the birth event. However, the choice of informants was limited by three factors: (1) the number of families who include children at births; (2) the hesitancy of some family members in allowing an

"observer" to be present at a special family event; and (3) practical constraints, such as synchronizing the availability of parents, chil dren, and investigator at the unpredictable time of birth.

Initially I accepted into the study children of all ages who came to my attention as candidates for being present at childbirth. 107

I accepted children in families planning home or hospital births which were attended by obstetricians, certified nurse midwives (CNM),

Arizona-licensed midwives, or naturopaths. As this was an exploratory

study focused on children's views of birth it was considered unneces

sary to control the variables of location and practitioner.

Seeking Informants. In order to find as many English-speaking informants as possible, I contacted individual practitioners, and met with groups of midwives and institutional committees in order to assure complete and approved access to all potential births where the presence of children was anticipated. In August 1982 my preparatory activity included: meeting with four CNMs who attend births at a local communi ty hospital; providing a written research proposal and attending a meeting of the community hospital protocol review committee; telephon ing and mailing my research proposal to a CNM in private practice who attends hospital births; discussing the study with two CNMs in the process of opening a free-standing out-of-hospital birth center; meet ing with an osteopathic physician and office nurse who attend home births; attending a group meeting of six licensed midwives who work to gether in a "birth co-op" and attend home births; telephoning a private obstetrician who allows children to be present at hospital births; meeting with three naturopathic physicians who attend home births; and telephoning two Arizona-licensed midwives in private practice who attend home births.

All of these 21 providers of obstetrical care agreed to inform me of clients known to be anticipating the inclusion of siblings at 108 births in the coming months. Several practitioners recently attended three births within the month of August where large families included between three and seven children at the respective births. After I learned of the scarcity of autumn births with planned participation of children, I decided to also interview children who had recently witnessed childbirth.

Negotiating Entry. The practitioners informed their clients who were considering including children at the birth event of my re search and asked permission to give the clients' home telephone num bers to me. During the next four months I received names, ages of children, due dates, and telephone numbers of midwives and naturopaths.

I established an initial contact by telephone with 19 families, which included 36 children who either had witnessed a childbirth recently or planned to be present at a birth in the coming months. I explained my study to the mother. If she agreed, I arranged an appointment when at least she and the children would be available.

A total of 11 out of 36 children, three boys and eight girls with an average age of 3.6 years, did not participate in the study for a variety of reasons. For instance, a grandmother took six-and four-year-old siblings on an extended camping trip, much to the dismay of the mother, who wanted them present at the hospital birth. The mother felt the grandmother disapproved of including children at the birth, and therefore, planned an alternate activity.

A maternal grandmother of a potential informant in another family also felt uncomfortable about her two-year-old granddaughter 109

seeing a baby be born at home. The grandmother was to be the caretaker

of the child during the birth. The pregnant mother and her husband

felt uncomfortable about her mother being present during the birth, but

did not want to offend the mother by excluding her. The pregnant woman explained to her mother that she wanted to keep the birth very

private by including only her husband and the midwife. To maintain

their rationale it was not feasible for me to be present. The grand mother and the two-year-old were not present at the birth.

In another family, the grandmother convinced the parents that

their five-and six-year-old daughters should not be at the hospital

birth, according to the mother. Other parents considered allowing old er siblings to participate, but for unknown reasons, changed their minds. One pregnant mother was agreeable to my presence at the home birth in order to observe the two-year-old daughter. When the husband returned home after work, he informed his wife of his preference not to include a stranger.

Another family planned to have their three-year-old son present at the home birth, but the mother ultimately went to the hospital for delivery due to a breech position of the fetus. Another child, six years old, was living with her mother when her pregnant stepmother went into labor; therefore she was unable to be present for the home birth.

Two other families, one planning a home birth and one a hospital birth, seemed to be ambivalent about intentionally choosing to include a stranger and observer. They postponed making a decision, and resolved the situation by avoiding the question until the baby was born. 110

Understandably, some parents hesitated to include an investiga

tor at the birth event. To request access to a birth is a large favor

to ask of anyone, and especially of families who are sensitive to the

family-centered nature of childbirth. Families choosing alternative

locations for birth, for example a home, birthing center or birthing

room, are frequently motivated by a desire to control the environment

in some way. One way is by restricting those allowed to be present, in

contrast to "routine hospital deliveries" where innumerable personnel

come and go at will in the labor and delivery rooms. None of the

families objected to their children being interviewed, but it was

apparent that gaining access to births with children present would be

difficult.

One family planned a home birth and was willing to have me be

present in the home, but not in the bedroom where the birth would take

place. The grandmother planned to be present in the home to watch the

children and help in other ways, but she also was not welcome in the

bedroom. The mother and father added a note to the consent form stat ing their willingness to have me in the home to interview and observe

the six-and four-year-olds, but not in the birthing room. The six- year-old was an informant in the study. I interviewed her and collect ed a drawing approximately one hour after she witnessed the birth of her sibling.

Four families consented to allow me to be present at their births as a participant-observer. Out of these four possible chances to be present with siblings when a baby was born, I was able to observe Ill only one three-year-old boy at a hospital birth in the middle of the

night. In the second family giving me consent to observe a child, the mother called when she went into labor. Within the hour, before I left my home, the father called to tell me not to rush as the baby had just been born, under his guidance. The midwife also had not arrived.

The two-year-old was busy playing at the neighbors while her father caught the baby.

A third family agreed on the telephone to my participation at a hospital birth. The day before my scheduled appointment to meet the parents and three children, explain the project, and get consent forms signed, the mother went into premature labor, almost three weeks before the anticipated due date. The midwife informed me during the night of the labor and the children being present, but due to ethical consider ations, I did not want to intrude on this family birth at the last minute. The fourth consenting family had a very rapid home birth in the middle of the night. Understandably, I was not called.

The difficulty in obtaining direct observations of children became apparent. Observations were important especially to gather data from the younger preschool children. After three months of collecting data from 25 children of all ages, I decided to focus on six-to twelve- year-old children, based on their ability to verbalize, classify, draw and describe. Eleven children, six boys and five girls, were excluded because of age. Without direct observation of children, the language 112 and cognitive developmental levels of the school age child were essential in gathering data using the methods of ethnographic interview and drawings.

The Research Design

The ethnographic approach is used to answer the following re search questions: (1) What is the six-to twelve-year-old's view of childbirth? (2) How do children conceptualize birth in contemporary

American culture? and (3) What factors influence children's participa tion at childbirth? This section discusses qualitative research in general, along with ethnographic interview and analysis and the use of children's drawings as specific methodologies. The setting, "getting in," and procedures for data collection and analysis are described.

Qualitative Research

Questions arise in many disciplines when a qualitative research approach is selected. In many ways, nursing research lends itself to qualitative methodologies. Frequently in nursing research, the sub jects are also the patients and clients. They are complex human beings living in a multivariate society and attending to health and illness concerns in hospitals and clinics, both settings which are difficult for the researcher to control.

The ethnographic approach, a qualitative methodology, seeks to discover and define variables for eventual quantitative study. It in volves the generation of, not the testing of, hypotheses. The ethno graphic approach is used to describe information about a whole, such as 113 a culture or subculture. Nurses, psychologists, and sociologists have joined anthropologists in the use of ethnographic methods.

Among nurses, the importance of applying anthropological con cepts and methods in nursing has been advocated for over a decade

(Byerly 1969, Osborne 1969, Leininger 1970, Ragucci 1972, Brink 1976,

Bauwens 1978, Kay 1982). "The significance of ethnographic methodol ogies for nursing research and practice is based on the assumption that any methodology which allows for the discovery of variables in health-related situations can contribute greatly to uncovering the complexities of nursing practice, developing nursing knowledge and eventually, nursing theory (Aamodt 1979, p. 1)."

Kay (1982) edited a book, Anthropology of Human Birth, of ethnographies of birth which analyze the way birthing systems operate within whole cultures. Birth beliefs and practices are described in the ethnographic data, and the authors interpret the data and seek ex planations for current obstetrical practices.

Using a qualitative methodology, Tripp-Reimer (1982) studied barriers to health care. She investigated the variations in interpre tation of Appalachian client behavior by Appalachian and non-

Appalachian health professionals. Detailed data were gathered during semi-structured informal "interviews," similar to guided con versation. Data were analyzed by identifying topics, comparing and clustering data into categories. "The qualitative design enabled the discovery of perceptual differences of client behavior based on the 114 background of the professional. Neither the dichotomy of interpre tation of client behavior, nor the prevasiveness of this dichotomy was anticipated prior to cluster analysis (Tripp-Reimer 1982, p. 189)."

The most important limitation with qualitative methdologies is the lack of generalizability. Because the results cannot be considered representative of the larger group beyond informants, "policy or pro gram recommendations cannot be directly extrapolated from qualitative data (Tripp-Reimer 1982, p. 189)." Qualitative research lends itself to a description of the whole, to the identification and definition of variables, and to the inductive process of generating theories.

Kramer (1974) and Kramer and Schmalenberg (1977) used a form of the ethnographic method to identify reality shock and biculturalism in the nursing world. Their approach to nursing from a cultural point of view led to description, analysis and theory formation. Ethnographic description "requires methods of processing observed phenomena such that we can inductively construct a theory of how our informants have organized the same phenomena. It is the theory, not the phenomena alone, which ethnographic description aims to present (Goodenough

1957, p. 168)."

Various researchers have developed theories grounded in empirical data of rich ethnographic description, which Glaser and

Strauss (1967) referred to as grounded theory. They used this method to identify and describe open and closed awareness contexts surrounding patients who are dying in the hospital. 115

Several nurses have generated theories grounded in empirical

data of ethnographic description that have relevance for providing

health care. For example, Stern (1976) studied the integration of

stepfather families. As no theories existed and no variables were de

fined, she used in-depth interviews to discover what problems existed

in the social scene, and how the persons involved handled them.

Qualitative analysis was used to generate a theory from the empirical

data.

Wilson (1977) studied an experimental community for schizophren ics and generated the concept of limited intrusion, that is, not allow ing the public to see behavior in severely disturbed individuals that

the public might not understand or accept. Atwood (1977) used grounded theory to identify the phenomenon of selective neglect, which works in two ways: (1) families selectively care for,, sick family members in order to keep them home as long as possible until the medical needs can no longer be selectively unattended to, and the patient is admitted to the hospital; and (2) in the hospital, health professionals selectively neglect the needs for which the family has been so diligent in meeting, and selectively attend to medical care.

To summarize, qualitative research concerns the identification of variables and the generation of hypotheses and/or theories based on elicited descriptive information. Data for qualitative research can be elicited through ethnographic interview, participant or naturalistic observation, or drawings. Due to various difficulties in obtaining direct observation of children at birthing events, the ethnographic 116

technique of participant observation was not used in this study. The

techniques of the ethnographic interview and analysis, as well as the

use of children's drawings were the procedures used in this study.

These will be described in the following section.

Ethnographic Data and Analysis

The interview was used to discover how the 14 informants who had recently been present at childbirth described and defined their experience. Formal elicitation procedures and

taxonomic principles as described by Spradley (1979) were used to obtain and order the shared knowledge of children who had witnessed childbirth.

It was believed that being present at births of siblings, relatively similar events, would evoke similar perceptions in children of the birthing process—seeing the mother in labor, responding to the baby, and reacting to the sights and sounds of birth. The children's cultural knowledge of birth then could be abstracted from the experiences the informants described to the investigator.

Spradley (1979) emphasizes the importance of establishing rapport in order to achieve a close investigator-informant relation ship. To facilitate the rapport-building process, which is related to validity and reliability, he recommends making repeated explanations, keeping informants talking, restating what informants say, and not ask ing for meaning, but asking for use. Aamodt (1979) believes reliabil ity and validity in ethnographic research depend primarily upon investigator-informant relationships, long periods of field research 117

and observations of behavior supporting or contradicting ethnographic

data. In addition, Aamodt (1982, p. 142) maintains that "following the

data in the language of the informant is probably the most important

principle in the procedures for the ethnographic interview."

The premise of an ethnographic style of interviewing is that

information is gathered from the informants, not about them. The infor mation is collected in their native language in order to discover the meaning encoded in that language. Spradley (1979) conveys the impor

tance of adhering to the verbatim principle because the words, the folk

terms, informants use hold a key to their culture. Folk terms are cultural symbols that refer to something and that give an investigator access to cultural meaning as a system of symbols. The system of sym bols reveals how the folk terms are related to each other and thus to the cultural rules.

In order to adhere to the verbatim principle, I transcribed each tape in the days following the interviews to prepare for the next interview. Having a complete transcription allows for every piece of data to be compared with every other piece, rather than com paring totals of indices (Stern 1980). This process of coding, compar ing, categorizing and conceptualizing is always verified in the world from which it came, namely the informants.

The manner in which informants categorize their experience in dicates the meaning attached to particular perceptions and events. To uncover the system of cultural meanings, the bits and pieces (cultural symbols) are placed in larger categories called domains, and eventually 118

taxonomies, which reveal the internal structure of domains (Spradley

1979).

The ethnographic interview and analysis are done concurrently

and follow a cyclical pattern, in contrast to a linear pattern of

investigation used in quantitative research. The answers provided by

informants are used to discover other relevant questions, which are

then asked of the informants to add depth and clarity to the native's

point of view, which in this study is children's views of childbirth.

Inferences are then made from the analyzed data to identify

themes. Spradley (1979, p. 186) defines themes as "any cognitive

principle, tacit or explicit, recurrent in a number of domains and

serving as a relationship among subsystems of cultural meaning."

It is most likely that a set of major themes and minor themes rather

than one single abstract theme integrates a particular cultural scene,

for example the birth event. When themes are presented

It is incumbent on the credible theorist to provide the reader with adequate information about how conclusions were reached. To do this, the researcher communicates the range of data on which the analysis was made, so that both researcher and reader can make meaningful judgements about the value of the analysis in accurately representing the prominent features of the social world studied (Wilson 1977, p. 110).

Themes remain at a tacit level of knowledge, are usually simply taken for granted, and therefore are difficult to verbalize. 119

Thus, the strategies of using specific types of questions,

transcribing each interview, and developing and analyzing domains

allow for the identification of tacit themes, the relationships between

themes, and the relationships of themes to the whole cultural scene.

As with information obtained through the ethnographic interview,

the information obtained through children's drawings of a baby being

born represented a segment of the children's knowledge and beliefs

they hold about childbirth. The drawings were not analyzed as pro jective test data; rather the drawings were considered ethnographic data which consist of the identification of content and the child's de scription of the drawing. As with other ethnographic data, the draw ings were analyzed according to categorization of content found in the drawings and the descriptions.

The Setting

The setting for data collection was in the homes of the chil- ren—in the bedroom, living room or kitchen, depending on the choice of the child. Interviews were frequently done in the child's bedroom and drawings at the kitchen table. I usually urged the informant to select a quiet place for the interview so we could concentrate and talk with out too many interruptions. I felt the children were more candid when their parents were not in the room. The children responded to my seriousness to participate in this study. The children seemed proud to be sought out specifically to share their knowledge about child birth. 120

When I narrowed the age range to include only six-to twelve- year-olds, younger siblings felt left out, as demonstrated by fre quent requests to talk into my tape recorder or to draw a picture for me. I usually accomodated their first-time requests. Eventually they accepted that the "university lady" came to talk with their older sib lings.

During conversations with younger siblings and parents, I had an opportunity to briefly observe the informants interacting with their parents and siblings, including the newborns. As an outsider I ob served the total environment—the house, the objects, the people and events, in other words the social situation. Spradley and McCurdy

(1972) have distinguished between a social situation and a cultural scene. The cultural scene "is more than a jumble of parts. It con sists of a system of meaning that is integrated into some kind of larger pattern (Spradley 1979, p. 186)." This study focused on the cultural scene of school age children and sought the insider's view, namely the children's view of the birth event.

Getting In

As described previously, appointments were made by telephone with mothers in ten families, which included 25 children. My purpose on the first visit was to introduce myself and explain the study to the parents and children. After meeting the family members and giving a verbal explanation of my study, I presented a parental consent form to one or both parents (Appendix B) and a child consent form (Appendix C) 121 to each child who could read. Children signed their own consent forms, sometimes after a parent or myself read the form to them or explained certain words.

The consent forms described observations and interviews occur ring at three points in time as initially planned: during the third trimester of the pregnancy, during the birth, and following the birth in the first month. In actuality, four of the ten families were con tacted before the birth, but in only one family was I able to observe and interview at three points in time, as planned.

The study was approved by the University of Arizona Human

Subjects Committee. A disclaimer format for subjects to read before giving oral consent to the research was technically and ethically adequate. However, because of the uncertainty involved with child birth, and the newness of the practice of including children, I decided a signed consent form with a full written explanation which the family members could refer to would be beneficial for all. In addition, the child's consent form served as a contract between me and the child.

Signing a form bestowed importance on our agreement to talk together about childbirth.

The agreement between child and investigator was also sanc tioned by one or both parents, usually the mother, who served as a go-between. A "middleman" in ethnographic research has an important function of assisting in establishing trust and gaining cooperation, both very important, especially when working with children. All the parents in the study were cooperative and were interested in the study and expressed eagerness "to read my report." 122

A demographic data sheet was filled in, usually by the mother,

at the first visit. In some cases I proceeded to interview children

and collect drawings on the first visit, according to the wishes of

the family members. In other cases I made an appointment with the

children and their mothers to return.

Data Collection and Analysis

The ethnographic interviews, a series of three to five inter

views with each informant completed over a four month period of time,

were audiotape-recorded. The children were usually eager to hear

their own voice played back—some smiled and seemed pleased, others

giggled and seemed embarrassed. Taped interviews lasted from 15 to 60 minutes, but frequently I would turn off the tape for digressions and

interruptions, such as trips to the bathroom, or to the kitchen for food, or a display of a favorite "smurf" or matchbox car. The first inter views included broad topics, such as childbirth. Initial questions encouraged the informants to describe their experiences and freely express their views. Later interviews focused on specific topics for clarification, for example, blood, and also included card sorting, a technique to elicit, verify and discuss emerging categories.

Drawings were often collected on the first or second visit. An opportunity to establish rapport with the children and their family was afforded during the drawing time. The materials used for the drawings included 13-by 17-inch white drawing paper and seven water-based crayola markers (red, blue, green, black, brown, purple, and orange).

The children were requested to draw a picture of a baby being born. 123

After the drawing was completed the children were asked to tell me

about their pictures.

I consciously strived to create a balance between being friends

with the children and making our encounters fun, and being serious

about my project and the information they were giving me. The poten

tial dangers lurking for the too-serious researcher were boredom of

the children, lack of cooperation, fear of "interrogation," and general

refusal to participate in the study. But I was also concerned that

the children know I was in earnest about this project, and that I was

sincerely interested in their point of view. The children seemed to

understand and maintain this balance between fun and work. It was

reassuring one day to be met at my car by an eleven-year-old informant

and his neighborhood friend. He proudly informed his friend that he

couldn't play now. "She needs to talk with me about something." In

another situation, a mother forgot to tell her eight-year-old daughter

that I would interview her after school. She went to a friend's house

to play. Her mother telephoned and said she must come home. She sadly

left her friend. I anticipated a reluctant informant, but she eagerly

tackled the "tasks" at hand.

The "tasks" followed the guidelines for the ethnographic inter

view, as described by Spradley (1979). The three most important

ethnographic elements of the interview included: (1) explicit purpose;

(2) ethnographic explanations; and (3) ethnographic questions. In order

to convey the purpose to the informants, I explained to them at each

session that I wanted to know what they thought about childbirth, that 124

I wanted to know the child's point of view. I frequently reminded them that there were no right answers.

Following the statement of purpose, I would tell them the general plan for the day, such as talking into the tape recorder, draw ing a picture, or sorting cards. On the first encounter I would say something like: "Today I would like for you to tell me as much as you can about what happened on the day the baby was born." In later en counters, I would inform them: "Today I have a lot of cards I want you to look at and sort into piles." I attempted to keep the children goal-directed until they became restless, usually within 30 minutes for the younger children. At times I would coax them through one more question or card-sort, with the promise that we would then stop. Each session, upon completion of the tasks, I gave them several stickers of current interest to children.

The second element of the ethnographic interview is the enthnographic explanation. Samples of four types of explanations used with the children follow: (1) "I want to learn from children about what it's like to see a baby come out. This will help moms and dads, doctors and nurses understand kids who are there when a baby is born"; (2) "I use the tape recorder in order to listen to what you tell me after I go home, and then I write it down on paper with my typewriter"; (3) "Today

I have many cards with words on them—things children have told me about birth. Do you think these cards belong in this pile 'The best part of being there?' " and 4) "This time I am going to ask you some of the same questions I asked before. Maybe you will remember some more things to tell me this time." 125

I believe that if children are informed of the plan and what is

expected, they are more likely to cooperate. I tried to avoid confus

ing or insulting the children by asking for information which they

already knew I had received from them. Nevertheless, through my ex

planations the children became used to' recognizing topics and repeating

answers from previous sessions. They always seemed pleased to identify

their own phrases that would appear on cards for them to sort into

categories and would comment, "That one's mine."

A ten-year-old quickly learned each new task and advised me

when he contributed a new piece of information: "You better put that

on a card." He was successfully trained to be an informant. He under

stood his role of teaching me about his views of childbirth, and of

painting a picture of the larger culture of childhood.

The third element of the ethnographic interview is the

ethnographic question. Spradley (1979) has identified three major

categories of questions, each serving a specific function: (1) descrip

tive questions to collect an ongoing sample of the informant's lan

guage; (2) structural questions to discover information about domains

in order to find out how informants have organized their knowledge; and

(3) contrast questions to discover differences among folk terms and

thereby discover tacit relationships. Examples of these three types

of questions used in this study are listed below:

Descriptive Questions 1) Tell me from beginning to end what happened when the baby was born. 2) What would you tell a friend who didn't know as much as you? 3) What should kids know about birth? 126

Structural Questions 1) Tell me what kids do at a birth. 2) What kinds of things did your mom do when she was in labor? 3) Would you use the term "gross" for the first time you see a birth? 4) Would you say these 18 cards include all of the steps in babies being born? What steps would you add? Contrast Questions 1) What is the difference in being scared at birth and being scared at a horror movie? What are the other scary things? 2) Would you say these steps in a baby being born are gross or scary? 3) What are the differences in missing a baby being born and missing Christmas? What are some other things you wouldn't want to miss?

The three types of questions are used interchangeably during in terviews, after the informants are trained in the use of each. After initial interviews, based primarily on descriptive questions, data from transcribed tapes are examined and grouped into major categories of in formation called domains. From this analysis, structural and contrast questions are developed for future interviews to learn how informants organize their knowledge and to seek themes. Card sorting is used to assist in categorizing large domains. Data continue to be collected and analyzed in a circular fashion until all categories are saturated, that is, until the informants are no longer contributing new information.

The analysis is an organized process of examining the ethno graphic information to determine: (1) its parts, or folk terms, which are displayed in domains 5 (2) the similarities in relationship among parts which are displayed in taxonomies; (3) the differences in rela tionship among parts, which are displayed in contrast set or dimensions in contrast; and (4) the relationship of parts to the whole, which are 127 discussed in themes. In this study domains, consisting of

groups that contain one or two subsets, and taxonomies, consisting of

sets of catagories with three or more subsets, are referred to as

domains of meaning.

Taxonomies are usually organized on the basis of a single

semantic relationship, frequently the relationship of strict inclusion:

X is a kind of Y. In this study, there are exceptions to single

semantic relationships in the taxonomies in order to include as much data as possible to convey the child's view of birth. Some taxonomies also include folk terms related through attribution: X is a character istic of Y.

The search for contrast sets is referred to as componential analysis. Contrasts among members terms of a category are organized in a systematic fashion and represent the components of meaning for specific folk terms and their multiple relationships with other cul tural symbols (Spradley 1979).

The domains of meaning and contrast sets come together to form

the themes, which are the recurring patterns that make sense

of and give meaning to the bits and pieces of data (Spradley 1979).

The themes connect the system of symbols. Themes are frequently recurrent expressions of the informants, but they are inferred from the data by the investigator.

In conclusion, this chapter on methodology presented a profile of the researcher, children as informants, and the study informants. The significance of the researcher-informant relationship in ethno graphic research was discussed. The process of selecting six-to twelve-year old children as informants and negotiating entry for collecting data was described. A limitation of study was the lack of access to directly observe children at birth, a way to corrob orate the "ideal" cultural knowledge shared by the children by com paring it with the "real" behavior displayed at birth events. This study was based on a qualitative research design which used the enthnographic interview and children's drawings to gather data, which were analyzed using an ethnographic approach. The data collected and analyzed in this study are presented in the following chapter. CHAPTER 6

PRESENTATION AND ANALYSIS OF DATA

This chapter begins with a section on the characteristics of the sample, which includes information about the informants, their families, and the birth events witnessed by the informants. The data are organized in domains of meaning and contrast sets depicting the child's view of childbirth. The drawings are discussed in the text.

The drawings, which are photocopied in black and white and reduced in size, and the children's descriptions of the drawings are located in Appendix E. The chapter ends with a delineation of themes inferred from the data.

Characteristics of the Sample

The findings of this study are based on interviews with four teen informants from seven different families. The fourteen general informants, including six key informants, are described in this sec tion. Their families are also described. Pseudonyms are used through out the study to identify the informants and their families. The names and ages of informants and the ages, years of education, occupa tion, ethnic group and religion of parents are reported in Appendix D.

Selected birth experiences witnessed by the informants and assisted

129 130 by birth attendants are described in order to provide an account of the variety of birth scenes in which children were present.

The Informants

The fourteen informants ranged in age from six to twelve.

Eight of the children in the study were girls and six were boys. All of the informants spoke English as a first language. There were no significant language barriers. The sample included four Mexican-Ameri- can children who also spoke Spanish. Eleven informants attended neighborhood public schools. Sherry and Paul Thomas were enrolled in a private Christian academy. Bess Connor, who lived in the most rural lo cation, rode a bus to a consolidated school.

The six key informants included three pairs of siblings who witnessed their mothers giving birth in August 1982. The first pair of siblings. Tanya (9 yrs. 6 mos.) and Jane (8 yrs. 1 mo.), plus a four-year-old brother watched their mother give birth to a baby boy, who surprised everyone by arriving three weeks early. He was born in a hospital labor room, attended by a certified nurse midwife, the father and three siblings.

The second pair of siblings serving as key informants, Bret

(10 yrs. 2 mos.) and Hannah (8 yrs. 2 mos.), witnessed a planned home birth. A licensed midwife came to assist the father. The father had unexpectedly delivered their previous baby in an unplanned home birth.

Bret and Hannah cared for their three-year-old sister during the birth. A brother (5 yrs. 8 mos.) chose not to watch. He had just 131

awakened from a nap and stayed in the living room on a couch. The baby

was born in the parent's bedroom with three siblings watching.

The third pair of siblings serving as key informants, Carl

(11 yrs. 9 mos.) and Grant (7 yrs. 10 mos.), were awakened in the middle

of the night to participate as planned in the home birth of a baby boy

born in the family room. They also took care of younger siblings dur

ing the birth. In addition, two women friends, one taking pictures

and one making a videotape, looked after the children.

These six children met the criteria for being good informants

as they were all recently involved in the cultural scene of childbirth

and, therefore, were enculturated sufficiently to provide extensive

detail on the topic. They were able to describe the events of child

birth with little analysis of the overall significance, and they all

had adequate time and were eager to talk. Because the key informants were available at the beginning of the study, I was able to interview

each of them five times and use many ethnographic techniques to collect

data. Thus, these informants were able to provide a sample of folk

terms, build domains and taxonomies, sort cards into contrast sets, and

thereby share the child's-eye view of childbirth.

Families of the Informants

The fourteen informants represent seven families. Five of the mothers in these families identify themselves as Caucasian, Anglo or

White. A sixth mother identifies herself and her husband as Mexican

American, and a seventh mother identifies herself as Anglo and her 132

husband as Mexican. Self-reported demographic data from the parents

of the informants, as given in Appendix D, reveal a diverse population.

The mothers range in age from 25 to 41 years, and fathers from 29 to

44 years. The mothers' years of education range from 11 to 16 years

and the fathers' from 12 to 19 years. Six of the mothers consider

their occupation to be homemaker or housewife, and one is a high school

mathematics teacher. The fathers' occupations include roofer (2),

lawyer, salesman, painter, brickyard manager, and building maintainence

man.

The families live in a variety of locations and types of hous

ing in and around Tucson, Arizona. The Ortiz, Connor and Thomas fam

ilies live in mobile homes in outlying areas. The Reddings and Landons

live in apartment complexes, and the Strauss and Moreno families live in

single homes, all within the city limits.

All of the families responded to the question on the demo

graphic data sheet regarding religion. Responses included Protestant,

Latter Day Saints, Lutheran, Christian, Jehovah's Witness, Presbyteri

an, Catholic, and Re-Born of the Spirit. During my contact with the

Connor family, it was apparent that being Jehovah's Witness was im

portant to them and influenced the birth event. Bess's four-year-old

brother shared the following comment with me one hour after the baby was born:

We don't have to be scared of the blood, cause daddy told me when I was in bed. When the baby's born there'll be a lot of blood. When the baby's being born we don't have to be afraid of the blood. It's very important to do what Jehovah 133

says when babies are being born. If you do bad things you can't live in the New System. When Jehovah tells us to listen to the baby we do what he always says. And always we do what he says we have to do, and that's all I have to say.

The importance of "religion" to the Thomas family also was ap parent. On the demographic data sheet the mother wrote "none" in the

"religion" blank, followed by "Re-born of the Spirit John 3:5-8."

Sherry wore a "Jesus" gold pin in the collar of her blouse. Her com ments during the interview were sprinkled with the following phrases:

"it's so like a miracle"; "It's just kind of a blessing"; and "We asked the Lord."

In summary, the characteristics of the informants, their fam ilies and their birth experiences were, in some ways similar, and in other ways quite diverse. In general, the life-style of the families was that of typical traditional nuclear families, with the fathers earning the income and the mothers tending the children and the home.

The one exception was the mother who is a teacher. The diversity was apparent in the ages of the parents, years of education, occupation, ethnic group, and religion.

Birth Events Witnessed by the Informants

All of the informants participated in at least one birth, with various degrees of involvement. Sherry, the oldest informant at 12 years 5 months of age, was also the most thoroughly enculturated into the childbirth scene. Sherry was present at the births of four of her siblings during the previous seven years and at two other births to friends of her mother...... 134

One of the births that Sherry observed was in the Ortiz family, where a total of 15 people, including 7 children, watched a calm

27-year-old mother of four "pop out" a baby. Two of the seven chil

dren were brothers of the new baby, and two were girl cousins, brought to the birth by their mothers who came to help their sister-in-law.

The father of the baby, his mother, and a two-year-old chose not to be present in the back bedroom -of the mobile home, but watched television in the living room. The father's mother tried to remove the children, but all of them strongly insisted on staying cramped together in the tiny back bedroom. The naturopath's assistant also suggested the chil dren leave, but Mrs. Ortiz convinced everyone that it was "OK" with her if they all stayed to see the baby be born. Eleven-year-old Lupe was deeply moved, according to her mother. Lupe told me:

She invited us all. It was nice of her to share her birth because most mothers don't want to do that. It was real nice of her (Lupe, 11 yrs.).

Mrs. Ortiz said the girls were more observant and talkative about the birth after it happened than the boys. The boys were also reluctant to talk with me and frequently offered no answer to open-ended questions.

As my questions became more specific, they would often say: "I don't know" or "I forgot." They preferred sorting cards into categories.

Melinda (6 yrs. 8 mos.) was the least involved of the infor mants for several reasons: the birth happened rapidly around midnight; the naturopath arrived three minutes before the baby did; and the step father was uncertain about his own role and even more so about the role 135

of the child at the birth. Melinda shared her perspective of waiting

in her room while the baby was born:

My dad said: "Calm down or else you're not coming." And finally my mom says: "Bring her in" (emphatically). And they didn't, and THEN they did afterwards (Melinda, 6 yrs. 8 mos.).

My field notes reveal the following entry on my observations of Melinda

and her family made several days after the birth:

When I called the mother by chance the day after the birth, the mother told me all about the circumstances of the rapid labor, the naturopath's arrival, her husband throwing up when he saw the placenta, Melinda's excitement about the baby, her interest in the naturopath's demonstration of the placenta, and her refusal to go back to bed at 2 AM; so she, her mother, and the new baby all slept on one bed, while the father slept in Melinda's bed. Melinda did not actually see the baby be born because her father told her to stay in her room. I have the feeling this was very painful for her and she is till grieving Over it, although she was not able to express any of this directly, partly due to the scene of the interview, which was in the living room. Her parents were both sitting at the kitchen table only a few yards away. Her father was drinking coffee and reading the morning news paper. Her mother was nursing the baby. Melinda is rather shy, and was often silent in response to my questions—espe cially so when it was quiet in the kitchen.

Melinda was the only informant who was actually not present at the

birth scene when the baby emerged.

The intended and actual location for birth was the home for all

of the families except for the Redding family. The Redding family

planned to include their three children at the birth in a hospital

birthing room. Unexpectedly, Mrs. Redding went in labor in the middle of the night three weeks before the anticipated due date. Tanya de

scribed the activities:

My dad came and told me and Jane to get up and my mom was in labor, and me and Jane washed our faces and got clothes on 136

and put our shoes on and went in the car and went to the hos pital. When my dad got to stoplights he honked his horn and went through the lights, two lights. Mom was having labor pains and me and Jane had to squeeze her hand. My dad helped her breathe in the car (Tanya, 9 yrs. 6 mos.).

Jane also described the event of rushing to the hospital:

I got up, jumped out of bed, got my clothes on, went in bathroom and brushed my teeth. I saw my mommy brushing them, and I don't know what else I did. [How did you feel?] I was kind of scared. (Tanya agreed that Jane was scared). [What was scary about it?] Well, I just didn't want my mom to go in labor cause she wasn't ready. [What did you think might happen?] She might have the baby at home (Jane 8 yrs. 1 mo.).

There were a variety of birth attendants who assisted the families. Children frequently called them "the ladies." The

Landon, Strauss, and Connor births were attended by licensed midwives, all females. A female naturopath helped the Ortiz family, and a male naturopath assisted the Moreno family. The Thomas family was rather secretive about any assistance, but the four births observed by Sherry were primarily attended by the father and friends.

To summarize the characteristics of the sample, the fourteen informants, ranging in age from six to twelve, came from seven families who were similar in terms of being traditional nuclear families, but were diverse in other demographic aspects. The birth events witnessed by the informants took place in homes, except for one hospital birth. Six key informants met the criteria of being good informants. The data were elicited from all fourteen informants. Extensive data were elicited over a longer period of time from the six key informants. 137

Domains of Meaning in the Child's View of Childbirth

Through the use of ethnographic interviews and children's de scriptions of their drawings, domains of meaning that compose the child's view of childbirth were identified. The domains included: (1)

People who do things at birth; (2) Steps in a baby being born; (3)

Things people do at birth; (4) Best parts of being there; (5) Worst parts of being there; (6) Things that are gross at birth; (7) Things that are scary at birth and in life; (8) Things that happen during three stages of birth; and (9) Things for kids to know about being there. Ethnographic data from all the informants were organized and combined into domains of meaning, which were then validated by the key informants. The ethnographic data have been presented in discussion of the nine domains of meaning in the child's view of childbirth.

People Who Do Things at Birth

The children mentioned 11 different types of people that were involved with childbirth (Figure 7). There were family people, such as mom, dad, kids, baby, and relatives. Relatives included cousins, aunts, and grandmothers. Helpers included midwife, doctor, nurse, the lady that takes the baby out, policeman, and "the ladies" (photographer, friend, and neighbor).

The people who were present at the births varied, as did the children's experiences, according to location of birth, family dynamics, individual children, choice of attendant, and characteristics of each birth event. For instance, the Strauss family chose to have a party in 138

mom

Family dad

kids

baby se H PS relatives cousin

H < aunt en o s grandmother M PS H midwife O Q Helpers doctor

w nurse hJ PU o w the lady that takes the baby out PK policeman

the ladies photographer

friend

neighbor

Figure 7. Domains of meaning in people who do things at birth 139 the middle of the night, including non-family members. Grant reported:

We celebrated. We had a coke. And mommy and daddy and the ladies that were here had Summit wine, and our neighbor made a cake that said "Introducing Randall Todd" (Grant, 7 yrs. 10 mos.).

Two sisters in another family both proudly excluded the item,

"having a party—celebrating, " when sorting the cards belonging to the domain "Steps in a baby being born." They responded as if it was a test question with right answers, and both were certain that having a party was not a "Step in a baby being born," and "People who do things at birth" included a midwife and a nurse, but not friends and neighbors.

People were usually present at birth for some reason, for ex ample, to perform some task. The informants were asked for the reasons they were present at the birth. They all agreed that they wanted "to see":

I wanted to see a baby be born for the first time. I just wanted to enjoy it so I wouldn't have to stay home with the babysitter (Jane, 8 yrs. 1 mo.).

I wanted to see what it was like, and where the baby came out (Hannah, 8 yrs. 2 mos.).

I wanted to see it be born. I kept on asking my mom: "When can I see a baby be born?" And she goes: "Whenever 1 have the next one. [Why did you want to be there?] Cause I wondered how—at first I thought, do they cut your stomach open and then sew it back. How do they get out?— until my mom told me, but then, well, I didn't really under stand, so I wanted to see the baby be born (Bret, 10 yrs. 2 mos.).

I wanted to see how it was like and how someone had a baby, not just on TV cause on TV they don't show you every thing (Lupe, 11 yrs.). 140

I wanted to see how it happens, because in the films it wasn't no good. You couldn't see it happening. You could see a quick glimpse of the crowning or something (Carl, 11 yrs. 9 mos.).

I wanted to see what it was like cause I never seen a baby be born before (Bess, 6 yrs.).

I never seen it before, and it was a great experience for me cause I had never been to a birth and because I wanted to know the facts about birth (Paul, 7 yrs. 10 mos.).

Some of the informants considered it a rare opportunity to view a birth, and wanted to take advantage of a new experience in order to add to their knowledge about birth. According to two informants, "how it happens" is inadequately shown on television and in films. Some of the children had unanswered questions, which they hoped would be re solved by a first-hand viewing of childbirth.

The informants were also asked for their opinion on the reasons their parents wanted them present at the birth. Taking another's point of view and their own view simultaneously in order to view themselves as an object was a difficult task for children. Most children will achieve this capability sometime during the concrete operational stage of cognitive development. The informants made the following comments about their parents motivations to include children at the birth:

Maybe they didn't have anybody to watch us in the hall (Tanya, 9 yrs. 6 mos.).

Probably they couldn't find a baby sitter or something (Jane, 8 yrs. 1 mo.).

So I could see how it happened (Bret, 10 yrs 2 mos.).

They wanted me to see what it was like (Hannah, 8 yrs 2 mos.). 141

To see how it happens, so I know more about it when I have a baby when Im an adult (Carl, 11 yrs. 9 mos.).

So I'd know what birth looks like (Grant, 7 yrs. 10 mos.).

Probably cause I had never been to one before, and they thought it would probably be a pretty good experience for me cause maybe sometimes something like this would happen (Paul, 7 yrs. 10 mos.).

The children were able to verbalize their parents' perspective, which often matched their own reason for being there: "to see" the steps in

a baby being born.

Steps in a Baby Being Born

During the initial interview, all informants were asked the

same broad descriptive question: "Tell me from beginning to end what happened when the baby was born." The folk terms used by the children

to describe the birthing process were put on cards. During the inter views that followed the initial interview, the key informants were asked to sort cards containing their own phrases as well as descrip tive phrases about childbirth from other children. They were encour aged to add information if any other steps came to mind. If more than one child confirmed a phrase as belonging to "Steps in a baby being born," that phrase was included in the domain.

The card-sorting task was handled with ease by the six chil dren as all knew how to read, and to classify and categorize, a level of cognitive development reached by most children between six or seven and eleven. If the child didn't think the phrase on the card was a step in a baby being born, that card was set aside. Some of the 142 children did not understand terms used by other informants, for example crowning, vagina, nursing, and placenta, and would set those cards aside. Other children substituted their own similar words, such as

"kagina" and "virginia" for vagina.

The domain of meaning "Steps in a baby being born" was con trasted with "What I felt like doing" by six key informants as shown in Table 3. The informants reacted in various ways at various times during the birth process. Some of them said certain steps made them feel like closing their eyes or leaving the room Other steps were things they didn't want to miss, or it didn't matter. To learn about the internal structure of the domain "Steps in a baby being born," I asked six key informants, Tanya, Jane, Bret, Hannah, Carl and Grant, to sort the member terms into three piles: (1) Want to close eyes or leave room; (2) It doesn't matter; and (3) Do not want to miss.

Want to Close Eyes or Leave Room. The two folk terms, "bleed ing when baby started coming out" and "seeing the placenta," were sorted by three informants into "Want to close eyes or leave room."

Tanya said she closed her eyes when the "doctor was taking the pla centa," and she felt like leaving the room when "the doctor was cutting mom." I asked Tanya about her desire to leave the room, and her choice to stay. She said:

I had to stay there so my dad could keep an eye on us, so we wouldn't run off. My mom's friend was going to come, but my mom couldn't call her when she got to the hospital. [If she had been there would you have left the room?] No, because I wanted to stay with my mom (Tanya, 9 yrs. 6 mos.). 143

Table 3. Three dimensions of contrast in domains of meaning in steps in a baby being born (* n=6 Each X represents one informant)

WHAT I FELT LIKE DOING to close It doesn't Do not want to miss eyes or leave room Want matter

Mom breathing funny—fast and deep X* XXX XX Mom's face rfed XX X Mom sweating XXXX X Kids watching the birth XX XXX Mom on all fours to break bag XXX X Breaking bag of waters X XX XXX Midwife sticking fingers in to feel head X X XXXX Opening of vagina XX XXX Bleeding when baby started coming out XXX X XX Doctor cutting mom X X Crowning XXXX Head sticking out XXXXXX Shoulders coming out xxxxxx Baby slips all the way out xxxxxx STEPS IN A BABY BEING BORN Baby crying XXXX XX Seeing the cord xxxxx Cutting the cord X xxxx Seeing the placenta XXX XX Putting baby on mom's belly X xxxxx Nursing XXX XX Deciding what to do with the placenta L_X XX Having a party—celebrating XX 144

Tanya's sister, Jane, also put the two items of "bleeding when baby started coming out" and "seeing the placenta" into the category "Wanted to close eyes or leave room."

Well, I didn't close my eyes, but I turned around in my chair. The bleeding was the part I really hated (Jane 8 yrs 1 mo.).

Bleeding and blood became folk terms with cultural relevance to children who witnessed childbirth. Hannah placed three folk terms into the category "Want to close eyes or leave room": "bleeding when baby started coming out," "seeing the placenta," and "cutting the cord." She explained:

I told my mom to tell me when something else was on because 1 didn't like seeing the baby, I mean I didn't like seeing the blood. I asked her to tell me when she stopped bleeding be cause I really didn't like seeing the blood. She told me when you really couldn't see the bleeding very good (Hannah 8 yrs. 2 mo s.).

The comments about bleeding in the category "Want to close eyes or leave room" were made primarily by three girls. Out of 11 items placed in this category, nine were placed by girls. Two boys, Bret

(10 yrs. 2 mos.) and Grant (7 yrs. 10 mos.), seemed to consider closing their eyes or leaving the room to be signs of weakness. Both seemed proud not to place any items in this category. Carl (11 yrs. 9 mos.) was willing to place two items in the category "Want to close eyes or leave room": (1) breaking bag of waters; and (2) bleeding when baby started coming out. However, he felt the need to add a disclaimer at the end of his statement:

It's kind of sick because of the blood and all that coming out from the mom. It's kind of gross too like diarrhea coming out real fast and it's red. It's kind of sick. And bleeding and seeing the blood and the baby kind of makes you 145

worry too. And once in a while for little kids it makes them worry about their mom if there's something the matter. But I felt a little scared, but not really that much (Carl 11 yrs. 9 mos.).

Three girls did not feel the need to minimize or apologize for their urge to avoid scary or gross things. Data regarding gross and scary things were used in other domains of meaning, such as "Things that are gross at birth" and Things that are scary at birth," which are pre sented in this chapter.

It Doesn't Matter. Some of the comments about member terms placed in the middle category "It doesn't matter" are found in the fol lowing paragraphs. A "rarity scale" seemed to influence what the chil dren felt like doing; that is, if the step in a baby being born was rare, they didn't want to miss it. If the particular step was a common occurence, it didn't matter.

"Nursing" didn't matter cause it isn't really exciting cause I saw my mom nurse my brother and sister. "Breaking bag of waters" doesn't really matter cause I've seen it before. It just doesn't feel exciting to me. I saw it when my sister was born. It just looks like water coming out—like water on back of the chair. "Mom on all fours" didn't matter cause I've seen people on their hands and knees before. "When the blood keeps running out"—I didn't care about it cause I've seen blood a lot of times and it just doesn't matter (Hannah, 8 yrs. 2 mos.).

Hannah used a criterion of whether or not she had seen something before to decide whether it mattered. A similar criterion was used to decide about things she didn't want to miss:

"Mom breathing funny—fast and deep," cause I never saw somebody breathe that way, and it was kind of funny. "Mid wife sticking fingers in to feel baby's head"—I like that cause, well I don't actually know. I.haven't seen it be fore—that's probably why (Hannah, 8 yrs. 2 mos.). 146

Carl's answers also indicated his curiosity in things he had not seen before, and his lack of curiosity in things he had seen before. He regretted watching the common event of nursing when a rare step was simultaneously happening. The following comments came in response to the items he placed in the category "It doesn't matter":

"Nursing"—You can see that after the baby's born. You don't really need to see it when it's happening, cause I watched the nursing, I don't know why, and I missed the pla centa coming out. "When vagina opens"—I can see that once in awhile like when my sister goes to the bathroom. Anyway, what's the big whoop about a vagina opening (Carl, 11 yrs. 9 mos.).

Some of the children had, in addition to a curiosity about birthing activities and new sights, a sense of urgency not to miss the head coming out or the placenta, even though at times they were ambivalent about remaining at the birth scene when things were gross or scary to them.

Do Not Want to Miss. All six key informants were unanimous about not wanting to miss the actual emergence of the baby: (1) head sticking out; (2) shoulders coming out; and (3) baby slips all the way out. I asked the key informants to tell me about these three things that they did not want to miss:

Cause that was when the baby was being born (Tanya, 9 yrs. 6 mos.) .

It's pretty interesting when most of the baby is coming out, and I've never seen a baby when it was first born, first day, right out. "When baby slips all the way out"— that was pretty neat too (Jane, 8 yrs. 1 mo.). 147

I didn't want to miss anything. I only closed my eyes when I blinked. I didn't put "mom sweating," "mom breath ing funny," or "baby crying" in "Do not want to miss" be cause I care about her (Bret, 10 yrs. 2 mos.).

I wanted to see the baby's face and what she looked like. I wanted to see how big the body was. I wanted to see how big the toenails were cause my mom was telling me how that the toenails were real little and the toes were too (Hannah, 8 yrs. 2 mos.).

It's all parts of labor (Car], 11 yrs. 9 mos.).

(Grant put every item in the category "Do not want to miss" and considered his task complete. I asked if he really wanted to see all the steps.) Right! (Grant, 7 yrs 9 mos.).

The children's curiosity seemed to draw them to "exciting" events and unusual sights. For instance, five children did not want to miss "seeing the cord" or "putting baby on mom's belly." Four chil dren did not want to miss the "midwife sticking fingers in to feel baby's head," "crowning," and "cutting the cord." The children's interest and curiosity included not only real situations, but also hypothetical ones. For example, Jane gave the following response when asked about placing "breaking bag of waters" in the category "Do not want to miss":

The nurse didn't really do that but I just didn't want to miss out on that if it happened, because it would have been neat (Jane, 8 yrs. 1 mo.).

Hannah admitted to closing her eyes while the cord was being cut and avoiding the placenta. I asked her if she felt like leaving the room. Her answer: "No, cause I might have missed something."

Carl also felt a pull to stay at the birth scene, even if he felt re pelled by what he saw: 148

I wouldn't go "Ah-h-h," I can't stand it. I would just stand it, even if I had to barf. I would probably barf all over the place instead of going. I can't stand to miss it. I have to watch (Carl, 11 yrs. 9 mos.).

In order to add perspective to birth as a "do not want to miss" event, I asked the children to compare and contrast "seeing a baby being born" with other events in life that they didn't want to miss.

Their list of "Do not want to miss" events included: (1) seeing a baby be born; (2) Christmas; (3) birthday party; (4) going camping; (5) see ing a favorite movie; (6) going on a troop trip; (7) staying overnight with a friend; (8) visiting grandparents; (9) taking a space ship to

Mars; (10) going to Disneyland; (11) being with my family at Easter;

(12) getting candy; (13) making a speech at school; (14) seeing the

Christ at Christmas; (15) going to church; (16) going to school; and

(17) going to a swim party.

A rating question, a type of contrast question, was asked the key informants in order to discover the values placed on sets of symbols of the culture of childhood. The children were asked which of all these events they didn't want to miss the most. Their answers, which indicated the significance placed by the children on seeing a baby be born,included the following remarks:

There's only one time you can see it usually (Carl, 11 yrs. 9 mos.).

Seeing a baby be born is most important not to miss, and next grandparents. [Is there anything you can think of you would not want to miss as much as missing a baby be born?] Being with my family at Easter. [That would be better than seeing a baby be born?l Ya. We get candy (Tanya, 9 yrs. 6 mos.). .149

Seeing the baby be born is most important of anything. Christmas is fun. Going on a trip is even funner because we go to grandma's house. We get to go to California. I'm not too interested in birthday parties—well, a little bit (Jane, 8 yrs. 1 mo.).

Almost three weeks later Jane reiterated her statement about not wanting to miss the birth. This time she generalized her desire

to see the birth to other children:

Actually, I didn't want to miss having the baby be born. Most people don't want to miss their mom having a baby, so most kids get to watch. [Why do most kids not want to miss it?] It's pretty interesting, and well, you don't want to go outside or nothing or play games or get a pop that they have at those little bars. You just want to watch (Jane, 8 yrs. 1 mo.)•

Children were asked a contrast question: "Which two of the many events you didn't want to miss seem the most alike?" The answers showed contrasts implicit in the culture of childhood.

"Visit to grandparents" and "seeing a baby be born" are most alike because you go someplace else, and stay over night ...[What ' s the difference between seeing a baby be born and Christmas?] You get presents at Christmas, and sometimes you get presents when a baby is born but only if you're in the room (Tanya, 9 yrs. 6 mos.).

I still wouldn't want to miss a birth, not even if it's a really neat movie. No, never. What if my mom doesn't have another. [What about Christmas?] Give me a time— when we were going to open presents? I'd wait to open the presents. [How about a birthday party?] Oh, there's plenty more birthday parties. [Can you think of anything you would rather do than see a baby be born?] Ya. Ya. Fly- in in a space ship up to Mars. If there was such a thing and I had never done it, I'd forget about the baby, and go on a trip to Mars (Bret, 10 yrs. 2 mos.).

I'd rather see my baby be born than a movie like "Annie" or"Secret of NIMH" or exciting trips with my Brownie troop because my mom might never have a baby again. She never had one with a midwife there so I could see, so I don't want to miss it (Hannah, 8 yrs. 2 mos.). 150

"Seeing the baby be born" and "birthday party" are alike because we had cake both times. "Christmas" and "birthday party" are alike because you get presents at both. [What's the difference between those two and seeing a baby be born?] Because you don't get any presents (Grant, 7 yrs. 10 mos.).

Melinda could not read the cards to sort. I read the cards and she selected "Christmas" and "seeing a baby be born," as things she didn't want to miss, and the baby being born was the most important.

Carl ranked the items from those that were "OK to miss" to those he "really didn't want to miss." His list and explanations in cluded the following:

(1) Favorite movie—I could stand to miss that, but I don't like to. (2) Birthday party—that's kind of nice cause you get presents. It's also kind of nice to give presents. It's better to give than to receive, and it depends who the party's for and who they invite. They really aren't for my age. You can wait. (3) Visiting grandparents—Usually won't be able to do it when you're little, and then they won't be around that much longer. (4) Going camping—that's fun. Get to sleep over and go fishing. (5) Sleeping with a friend— you can stay up all night and talk about stuff like girls or something, which I hate most of the time, and play Atari. (6) Christmas—that's hard to miss cause of getting presents. I wouldn't want to miss cause I like Christmas. (7) Seeing a baby be born—you can see it only once (Carl, 11 yrs. 9 mos.).

All of the children ranked "seeing a baby be born" in either the first or second place for things they did not want to miss. Bret preferred a trip to Mars and Grant chose Christmas because he "gets presents and candy," two items that are culturally relevant to chil dren. Both Bret and Grant placed "seeing a baby be born" in second place "cause I never seen it before (Grant 7 yrs. lOmos.)." Children seemed to value or prize rare situations, and recognized the opportu nity for seeing a baby born as an unusual family event which they did not want to miss. 151

In conclusion, there were many specific "Steps in a baby being

born" that the key informants did not want to miss. All six were

unanimous about not wanting to miss "seeing a baby be born." When the

domains "Steps in a baby being born and "What I felt like doing" were

contrasted, it became apparent that children were magnetically drawn

toward birth with an eagerness to see something new, and simultaneously

repelled away from it by things that were gross and scary. Culturally

relevant folk terms, such as gross and scary, were part of the cultural

knowledge of children which informed the children's behavior at birth.

Children used their cultural knowledge to interpret various aspects of

the birth scene, such as things people do at birth.

•Things People Do at Birth

The domains of meaning in "Steps in a baby being born" and

"People who do things at birth" are related through several taxonomies

showing the many things specific people do at birth. "Things people do

at birth" is a theme that organizes most of the cultural knowledge of

the informants. The domains of meaning in "Things people do at birth"

absorb some domains, such as "Things that hurt mom at birth," "Ways to

avoid gross and scary things," and "Ways of caring at birth," and it

pulls together the relationships of many domains, such as "Best parts

of being there," "Worst parts of being there," "Things that are gross at

birth," and Things that are scary at birth." These domains of meaning

are presented separately, but are closely related to the domains of

meaning in "Things people do at birth."

Data about "Things people do at birth" are organized in five separate domains of meaning: (1) Things moms do at birth; (2) Things dads do at birth; (3) Things kids do at birth; (4)

Things midwives do at birth; and (5) Things babies do at birth.

These domains of meaning reveal the system of cultural knowledge used by children to interpret childbirth and generate behavior. The taxonomies and folk terms reveal the internal structure of the meaning of childbirth to children.

Things Moms Do at Birth. The internal structure of the taxono my "Things moms do at birth," is displayed in Figure 8. Two categories are included that are especially noteworthy in regard to their cultural meaning to the informants: (1) being in labor; and (2) having the baby.

The informants viewed laboring women looking different: their faces were red and they were soaking with sweat and gritting their teeth. Laboring women did different things, most of which the children had not seen before, such as the way they breathed, had contractions, made sounds, burst the water sac, held their legs up, and pushed.

Hannah's drawing (Figure E-l, Appendix E, p. 250) showed how her mom had to hold her legs while sitting in the birth chair. The head was coming out. The three children were sitting on the bed observing the birth scene from a distance, while the father and midwife assisted the mother. In contrast to the mother working hard in Hannah's drawing,

Melinda drew a picture of her mom "resting and feeling happy" after the baby was born (Figure E-2, Appendix E, p. 251).

Bleeding is frequently mentioned by most of the informants in relation to mothers having their baby. Bleeding is a folk term that is discussed in four domains of meaning: (1) Worst part of being there; 153

Giving air to the baby, and vitamins and minerals Signing up on a sheet of paper Getting ready Being in labor looking different soaking with sweat red face looking like she was going into labor gritting her teeth finding a good walking around position standing up laying in bed holding her legs up relaxing not talking

33 breathing taking a deep breath and H PH holding it for awhile

PQ getting less air

H a certain way

o doing rhythmic breathing

M having contractions hurting t-L H feeling the baby kicking doing a hard job telling dad to shut up pulling dad's hair strangling dad strangling my wrist almost strangling me holding on to daddy's leg making sounds having little screams moaning groaning screaming being quiet Figure 8. Domains of meaning in things moms do at birth (continued on page 154) 154

Being in labor breaking water liquid coming out from (continued) inside her body kneeling on all fours just busting when the baby's ready to come squirting out against the wall bag bursting baby coming out with all the water pushing pushing and blowing like you're blowing a fire pushing to get the baby out pushing baby further, close to coming out face turning red 32 breathing deep H Pi sweating Having the holding her legs up H baby bleeding when baby started coming out

Figure 8.—Continued 155

(2) Things that are gross at birth; (3) Things that are scary at birth; and (4) Things that happen during three stages of birth.

"Mom having the baby" and "holding the baby" are closely linked to the domains of meaning in "Best parts of being there," such as

"seeing the birth" and "meeting the baby." Specific folk terms are discussed in the section on "Best parts of being there."

The informants did not perceive the morn relating to the children in any way during the birth. Tanya realized her mother was not avail able to her, and neither was her dad or midwife. Tanya would have liked to have asked someone two questions: (1) if the baby was going

"to come soon or later;" and (2) if her mom had "to be cut open on the stomach." She didn't ask because "there was nobody in there except the lady and she was too busy. My dad was helping my mom, and my mom was in labor" (Tanya, 9 yrs. 6 mos.).

Things Dads Do at Birth. Dads performed several roles at childbirth, according to the informants (Figure 9). Their tasks with the moms included helping them "do stuff," like relaxing and doing con tractions, and conforting them by holding and hugging them, along with other activities. Some informants viewed their father in an active role of birthing the baby, such as "trying to pull the baby out" and

"catching the baby."

Carl's drawing (Figure E-3, Appendix E, p. 252) depicts his father reaching out with long arms to comfort his laboring wife.

Paul's drawing (Figure E-4, Appendix E, p. 253) shows the father ac tively assisting with the birth of the baby. 156

Helping mom do helping her not to push stuff holding her up relaxing a lot not to push rubbing her back with tennis ball getting her ice water doing contractions blowing with her with mom squeezing mom's arm holding her down so she wouldn't move all around grabbing mom's wrist X H Comforting holding mom oi H FQ mom having his hand over her going "It's OK, just keep relaxing, it's going H

The dads also played a role in tending the children. The in formants viewed the dads as talking to them and telling them where to go. None of the informants perceived the dads as explaining things to them or comforting them, but rather of dad comforting mom. The role of dad was as an organizer or manager, frequently portrayed .as the gatekeeper, allowing the children in or out of the scene of birth.

In addition, the dads assisted the midwives by moving and pre paring equipment, and cutting the cord, a task undertaken by four fathers. In two families, the eldest child cut the cord.

Things Kids Do at Birth. Being there during labor, during birth and after birth and avoiding gross and scary things were the primary organizing categories for the domains of meaning in "Things kids do at birth" (Figure 10). The informants described themselves as finding a place where they could stay with mom, but primarily where they had a clear and direct view of the emerging baby. If a younger sibling strayed into their line of vision and blocked their view of birth, it was considered a "Worst part of being there."

The informants participated actively and .passively at birth.

At times the informants considered their role to be one of waiting for the baby and watching the birth event proceed before their eyes. As

Bret opined: "Seeing it is one thing that every kid should see done."

Two children, Jane and Sherry, drew pictures (Figure E-5 and Figure E-6,

Appendix E, pp. 254 and 255) which showed children watching and waiting at the birth event. 158

Being there betting on the color of the baby's eyes during labor staying with mom taking care of mom being nice to her feeling sorry for mom cause the baby was so chubby listening to the baby's heart waiting for a sister for contractions for baby playing with erector set playing a little game— Rubic's Cube worrying if there's something the matter she's hurting helping getting ice finding a place sitting in the chair freezing by the fan H sitting still OS M staying out of the way going outside just for a H < little while O squeezing her arm or leg o making contractions C/0 go away real tight o squeezing her hand w twisting her hand C/D O letting mom strangle my E3 M wrist and squeeze it EE E-H hard squeezing her wrist or ankle real tight taking pictures of relaxing mom smiling going oh-h-h all the different ways she was moving opening her legs getting ready for it to come out watching the birth contractions this purple thing open moving around so I could see his head missing placenta coming out if mom lets them Figure 10. Domains of meaning in things kids do at birth (continued on 159) 159

Being there almost barfing during labor caring for younger getting something to eat (continued) kids getting her to talk and calm down going to the bathroom telling not to make a mess interpreting birth telling sister things for younger kids explaining to her "Don't cry if there's any blood" explaining it doesn't hurt when cord is out staying quiet wondering about the color of the eyes and hair wondering if its a boy or a girl Being there sitting in a chair at the foot of the bed during birth hoping no one gets in the way feeling the baby's head when it's coming out seeing this purple blob coming out

AT BIRTH seeing the cord seeing what it's like watching it start turning red learning a lot of things about birth fixing my eyes on the baby Avoiding gross shutting eyes and scary plugging ears things turning around in chair real quick THINGS KIDS DO asking mom to tell me when she stops bleeding turning away turning my eyes putting my head on my shoulder and not watching stepping back a little Being there cutting the cord after birth seeing the placenta and all this neat stuff holding the baby seeing if the baby has everything taking pictures of baby feeling the baby's head right after it was born helping put on the clothes playing with baby helping put placenta in three bags helping take the chair apart and putting it in midwives car seeing the baby sucking its thumb on my mom's belly Figure 10.—Continued 160

Jane wrote a story on the back of her picture that fantasizes

a child in a very active role at birth:

All about having a baby. Mommy, mommy are you in labor? Yes, come and help me. Ding-ling, I'll get it. Hello. Oh, Hi daddy. Hurry, come home. Mommy's in labor. Never mind, mommy had the baby (Jane, 8 yrs. 1 mo.).

The informants frequently described a more realistic active role for

themselves: listening to the baby's heart, getting ice, making con

tractions go away, taking pictures, feeling the head, putting clothes

on the baby, and caring for younger kids. The four children in the

Strauss family spontaneously offered some of their possessions to the new baby: baseball cards, three Star Wars people, two matchbox cars, a Smurf, and a cuddly stocking doll.

The six- to twelve-year-olds viewed themselves as the major source of information and counsel to the younger group. Bret seemed I I proud of the behavior of his three-year-old sister, his protege:

She was there, but she was very good about it. She knew what to do. She didn't go out there. She knew not to. It was like she had seen this before and she had been told. It was like she knew exactly what to do, as if she was the biggest kid there. She was really calm. She really—wow— cause Hannah and I explained to her: "Don't cry if there's any blood or anything," and we explained that to her (Bret, 10 yrs. 2 mos.).

The informants did not describe parents, midwives, or any special care taker designated to "support" the children as telling things to the younger children or explaining the birth event.

Avoiding gross and scary things was something kids did at birth.

What they were avoiding is described in the domains "Things that are

gross at birth" and "Things that are scary at birth." Many of the ways of 161 avoiding gross and scary things involved actions to decrease sensory stimulation from the environment without actually leaving, such as shutting eyes, plugging ears, turning away and stepping back.

Leaving the immediate surroundings of the birth scene was something no one was willing to do. There were also many things children did not do at birth which are discussed in the domains of meaning in

"Things for kids to know about being there."

Things Midwives Do at Birth. For purposes of this study, all birth attendants are referred to as midwives. Midwives are described as primarily attending to the mother and to the baby during labor and birth (Figure 11). Bret drew a picture (Figure E-7, Appendix E, p. 256) which shows the midwife kneeling in front of the mother, who is reclining on a birth chair, and the father standing nearby, "helping her not to push." Bret drew four circles to represent himself and his three siblings. The informants viewed the midwife as having an active role in making the baby come out and caring for the cord and the baby.

The informants viewed the midwife as relinquishing the baby to the mother shortly after birth.

Several midwives demonstrated the placenta and explained its function and that of the umbilical cord and veins. Some children per ceived this as something midwives do at birth. Moat of the children considered it gross and interesting.

Things Babies Do at Birth. "Things babies do at birth," from a child's-eye view, included: (1) being inside mom; (2) coming out; and (3) being a new baby (Figure 12). "Coming out" was a category closely linked to the domain, "The best parts of being there." The 162

Bringing the birth chair Being there helping mom doing contractions during labor getting a cold washrag taking her blood pressure bringing cold cloths making mom go up like this (on hands and knees) looking to see if the baby's head was down there before mama pushed checking baby hearing the baby's heart beat sticking finger in to feel baby's head putting her hand in one more time feeling whether head or m H butt coming first BS M feeling baby's head pa trying to find the baby H c in mom's stomach o saying kids can be o there CO w Making the pulling out the plug > M baby come just pulling it out—not too fast, but sort of s Q out slow getting poop on their legs t/3 cutting mom open with a scissors u la getting the head pulling the head out M 33 turning the head H so the shoulders could come out holding it a certain way so it will come out nicely saying 'push a little' Caring for putting the baby on mom's belly the baby "brang" it up to my mom keeping the baby warm taking the blood off the baby weighing the baby on a scale Caring for tying it tight the cord cutting the cord putting a clip on it tying off the cord putting like a safety pin and tying it to the belly button Taking the "uterus" and pulling it apart and showing all the kids Bagging the placenta

Figure 11• Domains of meaning in things midwives do at birth 163

Being inside kicking on an off mom kicking hurts mom getting food through a tube and starting to grow starting pushing Coming out trying to get out crowning head sticking out shoulders coming out coming out more and more slipping all the way out popping out sliding out legs can't come out first looking all weird and slimy sc H not getting air so face is blue PS w popping a hole to get CQ out Being a new trying to open eyes to see what world is like H < baby making noise crying like he had a sore O Q throat crying kind of funny W w screaming PQ

Figure 12. Domains of meaning in things babies do at birth 164

children were interested in the newborns—how they looked, such as all

the things that changed color, and what they did, such as making

noises.

Things babies do at birth primarily involved activities with

other people, namely mothers, midwives, and children. In the taxono

my, "Things kids do at birth," children described their own activities with the infant, such as holding, helping and seeing. The mother was viewed as occupied with feeding the baby after birth. The dad was not

perceived to be directly involved with the baby after the cord was cut.

In conclusion, the domains of meaning in things moms, dads, kids, midwives and babies do at birth are considered the predominant domains of meaning that relate most of the domains of meaning in chil dren's view of childbirth. The domains of meaning in "Things people do at birth" reveal the system of cultural knowledge used by children to interpret childbirth and inform behavior.

Best Parts of Being There

The domains of meaning in "Best parts of being there" are shown in Figure 13. Children used words like "interesting", "exciting,"

"fun," "pretty good," "real exciting," "nice," "pretty interesting" to describe the member terms in this domain:

Right when I see the head, and as soon as it comes out then they go "OH, it's a boy or a girl," I just flip out with joy (Sherry, 12 yrs. 5 mos.).

Well, when the head was coming out I thought it was pretty interesting. It was nice to see the baby be born too. And when the b.aby is all the way out, that was real exciting to me and the family. But for my mom, she felt awful at the time, but she was glad I'm pretty sure (Jane, 8 yrs. 1 mo.). 165

Anticipating waiting to see if it's a girl or a boy the baby being excited standing there nervously Seeing learning a little more about how babies are something being born for the time Seeing the the head coming out birth baby coming out the body coming out w D3 the whole thing coming out W sc the baby popping out H the baby coming out more and more O 53 seeing it step by step M W the baby being born pa knowing the baby was safe 'cause its head was o out and its feet were in, and it was breathing Meeting the knowing it's a boy H baby knowing it's a girl

Figure 13. Domains of meaning in best parts of being there 166

The baby coming out was the best part of being there or else you'd be in bed. That's the whole thing (Carl, 11 yrs. 9 mos.) . >

"When the head was coming out"—that was good, because it was neat how his head was little and then it got bigger bigger and bigger and then his whole head came out. And "when the baby was born" is part of all the things. That's the best part, seeing him come out. "Seeing the body come out"—ya, it went slip, like ice sliding, like on a slide • s-w-i-p-s. "How the baby came out more and more"—it was like in slow motion, but then it got faster and faster and then it went slip (Grant, 7 yrs. 10 mos.).

The very best part was when the baby was born (Manuel, 6 yrs. 11 mos.).

Manuel's cousin, Deanne, agreed with him about the best part. Bess drew a picture (Figure E-8, Appendix E, p.257) of the baby's head com ing out, which was considered one of the best parts by all six key informants.

Other best parts included anticipating the baby's sex and condition, and meeting the baby. The children were interested in hold ing and attending to the needs of the baby. Deanne commented: "I held the baby as soon as she came out. She looked like a baby doll, and she cried." One of Tony's best parts was when he got to hold the baby after she was "cleaned up."

Some children considered "mom holding the baby" as one of the best parts. Tony drew a picture (Figure E-9, Appendix E, p. 258) show ing the mother in bed holding the baby, Tony and his younger brother standing near the bed, and the grandparents "coming to hold the baby." Bret omitted the term "when mom was holding the baby" from the 167 domain "Best parts of being there." He commented: "A best part would be when _I got to hold the baby, not my mom holding the baby.

Carl considered "holding the baby" a normal event, not a rare event qualified to be ranked in the category "Best parts of being there." He omitted the card "mom holding the baby" because "she does that all the time," which is also the reason he omitted the card "hold ing the baby": "You can do that anytime." The best part of being there was clearly the rare event of seeing the baby come out.

Worst Parts of Being There

The domains of meaning in "Worst parts of being there" were developed out of the answers to descriptive questions asked in the first interview. In subsequent interviews the informants sorted cards to validate the member terms in this domain, and also added additional terms (Figure 14).

Five of the six key informants gave much attention to the folk term, "blood running out," as revealed in the following comments:

I wanted to close my eyes when blood was running out cause I thought it was gross (Tanya, 9 yrs. 6 mos.).

That was sure the worst part, the grossest part, the worstest part (Jane, 8 yrs. 1 mo.).

That's the worst part of being there. It's kind of gross seeing the blood come out. You aren't there just to see blood come out, and you don't want to be there just to see blood come out. You really don't want to see blood com ing out (Carl, 11 yrs. 9 mos.).

When the blood came out there was a lot of it. A whole lot of it. A whole lot of blood was getting on mama and the baby (Bess, 6 yrs.). 168

Not knowing what 's going to happen Blood running out w . Camera not going off P3 w Waiting waiting for the baby H boring to wait with nothing to do O waiting for my mom to start having contractions 53 M waiting for contractions W CQ Worrying about mom on hands and knees F*h mom mom saying "What shall I do?" O thinking mom had to be cut CO H thinking it must have hurted really bad . Pi < . mom screaming Worrying about thinking baby wasn't going to come out H CO baby thinking baby had a disease PS o midwife could have dropped the baby's head IS having the umbilical cord cut seeing them cut the cord Worrying younger brother or sister would get in my way

Figure 14. Domains of meaning in worst parts of being there 169

It was apparent that most of the children considered blood to be gross.

Bret and Grant both projected a tough image and maintained there were

no worst parts except waiting. When Grant sorted the cards for "Worst

parts of being there" he included when the blood was running out, but

added that he "could stand it."

Some form of waiting was considered the worst part of being

there by four of the key informants. Waiting was difficult for a vari

ety of reasons, including fright, worry and boredom. Bret expressed

his dissatisfaction with the length of labor:

The worst part was waiting. That was boring. I mean BORING. Then we just wait, wait with nothing to do. Oh well, 1 got out my erector set, and I built a crane and then I took that apart and built a little car (Bret, 10 yrs. 2 mos.).

When Jane was asked if there were any things she wanted to add

to "Worst parts of being there" she said:

Well, I was scared because I thought—well, I'm not going to say this part because it's not too good. [Reassurance that there are no good or bad responses]. Well, I thought the baby wasn't going to come out or something like that, or had a disease or something. That's why I was scared and turned around real quick in the chair again. [When was that?] Two hours later when she was still having contrac tions. We got at the hospital at 5 AM, and it took two hours to do just that one contraction (Jane, 8 yrs. 1 mo.).

The concern for the baby was related to the length of time, which

seemed unduly long from the child's perspective. Hannah was also con

cerned about the length of labor. When I asked her if she knew what worried meant, she responded:

Ya, like you're real worried and you don't know what to do. Like you're worried the baby won't come out until the next day and it's not very good. [Was that something you worried about?] Ya, because it took so long (Hannah, 8 yrs. 2 mos.) . Hannah selected three items as the worst part of being there:

(1) waiting for the baby; (2) waiting for contractions; and (3) blood running out. I attempted to gain further information about worst parts through the use of the triadic contrast question which asks:

"Which two of these are alike and which one is different?" Triadic contrast questions proved to be difficult for the informants. Conse quently, they were rarely used. These questions required a higher level of abstraction beyond sorting and classifying. Hannah handled this type of question better than most of the children:

"Waiting for the baby" and waiting for contractions" be cause they're both the same cause I just couldn't wait to see what the baby would look like (Hannah, 8 yrs. 2 mos.).

Three weeks later in another interview, Hannah reiterated her statement on waiting, which serves as a validation of data. Hannah once again sorted the two items of waiting into the category, "Worst parts of being there:"

Waiting for contractions was the worst part of being there because I couldn't wait until the baby was born. I wanted to see him and I wanted to see what it looked like and how it cried because I saw a movie before and the baby cried real fun ny (Hannah, 8 yrs. 2 mos.).

Some children were concerned about the cord and the placenta.

Sherry expressed her feelings about the worst part, which involved cutting the cord:

It still kind of bothers me a little bit in a way to see them cut the "placenta." I know it doesn't hurt, but it still gives me the shivers to think about it. What if there were nerves in it? When the baby screams you think he's screaming over the placenta or whatever, and it's not really. He's just talking to everybody in the new world....At the first birth I learned it doesn't hurt the baby to get the placenta—the umbilical cord cut (Sherry, 12 yrs. 5 mos.). 171

Several children worried that a younger brother or sister would get in the way and they might not be able to see everything; for exam ple Carl' s comment about the "Worst part of being there":

If someone got in your way, cause you're worried ahead of time that someone will get in your way and you won't see the whole birth, and that would make you mad (Carl, 11 yrs. 9 mos.).

The desire "to see" was supported by another informant who experienced a younger sibling moving in her way:

I wanted to see everything that would happen and I didn't know what happened. I wanted to SEE (Hannah, 8 yrs. 2 mos.).

Worrying about mom and about baby is discussed in another sec tion in this chapter. To summarize, the worst part of being there in cluded the blood running out and waiting. In spite of the blood being gross and the waiting being boring and scary, another worst part was the fear that you might not be able to see everything—"the whole birth."

Things that are Gross at Birth

During the first interview when informants talked about the process of childbirth in general, it became clear that children consid ered certain things about birth to be gross and/or scary. On subse quent interviews I elicited numerous member terms belonging to the domains of meaning in "Things that are gross at birth" and "Things that are scary at birth." Eventually these domains were contrasted with each other in order to learn the taxonomic structure and ultimately the the explicit and tacit cultural knowledge held by children about birth.

It is assumed that their cultural knowledge about such things as what 172

Is gross and scary at birth is used by children to interpret child

birth and to generate behavior in the specific cultural scene of childbirth.

One of the questions I asked in the first interview was: "If one of your friends was going to be with her mom in the hospital when she had a baby, and she didn't know much about birth, what would you tell her?" Tanya replied:

I would tell her it is gross, and there was blood, and the mother would have a lot of pain. [What was the most gross part?] Nothing was gross. [Would you tell your friend it was gross?] If they never saw it before. [Would it be gross for the second time?] No (Tanya, S yrs. 6 mos.).

Seeing something for the first time is relevant to the cul ture of childhood. Tanya's drawing depicted the entire family at birth (Figure E-10, Appendix E, p. 259). She described the activity of each person. Her concluding remark was: "It was gross."

Defining Gross. The domains of meaning in "Things that are gross at birth" are shown in Figure 15. Words used to define gross include "ugly," "disgusting," "sick," "yuck" and "despicable or some thing like that." I asked Sherry how she would describe gross:

I would describe it as being—like you say throw up is gross. It doesn't look very pleasant, and you wouldn't want to talk about it or say anything about it during dinner. Gross to me is like when you say the word abomination. It makes you sick. It makes you want to have a headache or your stomach starts turning, and at school I guess we use it a lot. Someone will burp, and we'll say: "That's gross." It doesn't really make you want to turn or anything. It's an overused word at our school (Sherry, 12 yrs. 5 mos.).

Out of the six key informants, two of them considered their mom's body gross, three informants considered the cord and placenta 173

Mom's body the vagina was getting bigger and bigger and EC bigger H Pi seeing all the privates PQ green poop coming out of her H Blood blood keeps running out < so much blood w cn the blood made me almost barf o pi blood made me sick u so much blood after the baby came out w pi do-do and blood and all that comes out < Baby blue or purple < blue and bloody EC H still got that white stuff C/D Cord seeing it o Z touching it 32 Placenta touching it black or red

Figure 15. Domains of meaning in things that are gross at birth 174 gross, and four informants considered blood gross. Lupe said there was nothing gross to her: "I'm going to be one of those persons that give autopsies. It doesn't bother me." Out of the 14 informants' drawings, Lupe drew the only picture (Figure E-ll, Appendix E, p. 260) that included blood: it shows a large opening in the woman's abdomen, presumably the vaginal opening, and a small dot of black representing the baby's hair inside a small brown circle, which is within a larger brown circle. The small brown circle is surrounded by red marks, showing the blood coming out.

Bret rejected all the terms in the category "Things that are gross at birth." I asked if he could think of any things he would con sider gross at birth. His answer: "In this condition, no. In another condition, yes like at school."

Blood is Gross. Most of the descriptions about "gross" focused on blood. Comments from the informants relating blood to things that are gross included:

"When the blood keeps running out"—that's kind of gross to see. You think it's never going to stop. It's going to stop when there's no more left. "The blood made me sick"— it kind of did, but it didn't make me super sick. It didn't make me barf. It's gross when it comes out and it's wet. It's worse than inside because it's red. [Is it the color that makes it really gross?] Yes. The color red is scary. Well, at Christmas it isn't really gross. Just mainly blood is gross—like Dracula, fangs, blood dripping off them (Carl, 11 yrs. 9 mos.).

I don't like blood, and there was a whole sac of blood (Grant, 7 yrs. 10 mos.).

When blood kept running out it was so gross I almost turned around or asked my dad if I could leave the room, so I just turned around and shut my eyes. It's kind of gross for the person who has to watch (Jane, 8 yrs. 1 mo.). 175

Children, like adults, appeared to have different "squeamish- ness thresholds" that ranged from a fascination and interest in blood to "almost barfing," a physical reaction that was described as a rumbling or turning of the stomach. Other physical reactions to witnessing childbirth mentioned by the children at various times dur ing the interviews included: shaking, stuttering, shivering and heart beating faster. Some informants said they felt like crying a happy cry, had tears in their eyes, and/or a lump in their throat.

Some boys and girls considered blood gross, and other boys and girls omitted blood from the gross category.

Cords, Placentas and Babies are Gross. Carl was selected for the honor of cutting the cord. He thought it was gross to touch the cord and placenta, but that it didn't smell gross: "It's just part of the body." Children's descriptions of the placenta, baby and cord in cluded the following:

Ours was pretty clean, it wasn't gross, it was light blue. Everyone was saying "That's a pretty placenta," cause it was light blue. Lots of times it looks all black and red and it looks sick. But it was light blue and nice (Carl, 11 yrs. 9 mos.).

Seeing the cord was kind of yuck and it looked sort of gross and stuff (Jane, 8 yrs. 1 mo.).

It looks kind of gross. He's blue. He's bloody. He's still got that stuff, that white stuff. I always thought it wasn't very good to wash it off. My mom said it wasn't very good, cause it's like lotion to the baby. That's part of the stuff that made me think it was really really gross. (Sherry, 12 yrs. 5 mos.). 176

Bodies are Gross. Carl considered it gross to "see the pri

vates":

Well, it's kind of gross just seeing it a little. The more often you see it, the less it bothers you. When you're a kid it's kind of more prettier. Something like that be cause it doesn't have hair around it. But my sister (3 years old) is gross too. The baby is cute, seeing his little'thing (Carl, 11 yrs. 9 mos.).

His brother, Grant, also considered his mom's body gross at birth:

"Just gross because the vagina was getting bigger and bigger and big

ger. And there was poop coming out of her." Grant said all big peo

ple's bodies are gross after about 20 years of age. "Privates" was a word not understood by all the children. Children have a limited vocabulary, especially with terms referring to sexual anatomy and birth. Their vocabulary reflected words used in their family and among their peers. Jane seemed puzzled why the card, "seeing all the pri vates," was in the domain of "Things that are gross at birth" and said:

That wasn't gross. Seeing the privacy between your mom and dad, and mother and brother or something, that wasn't gross at all (Jane, 8 yrs. 1 mo.).

Bret distinguished between what would be gross at home and what would be gross at school in terms of body exposure:

When the doctor is here it's different. He's had patients so it doesn't matter. It doesn't matter if you see someone just in their underwear. It doesn't matter. At school it does matter, cause all of the boys go: "Don't touch the girls cause we're going to get corroded" (Bret, 10 yrs. 2 mos.).

Hannah was certain her mom's body was not gross: "It wasn't gross or scary because I've seen my mom's body a thousand times—a real long time and I've seen her for eight whole years." According to the 177

informants, when children get used to something it possibly is no long er considered gross. Tanya considered only the first birth gross, but not the second. Hannah considered her mom's body familiar, and there fore, not gross.

Getting Used to It. The amount of exposure to such things as blood, bodies and birth in general changed the children's views.

Sherry described the changes that happened to her through her experi ences with childbirth:

During the birth they had to change the sheets a lot, and I could never stand to pick up the blood, but I like to do that now, not to get it on me or anything, but just to help, and get used to it. I remember at my sister's birth when I tried to do that, I got really sick, and started to feel like—blood—yuck. Now it's nothing. The only thing gross to me now is washing our eggs, cause they're always dirty. The placenta used to be really gross to me—this big blob. It seemed, really weird to me when you cut the placenta. Now none of that bothers me any more, cause I've seen so many (Sherry, 12 yrs. 5 mos.).

In conclusion, some of the informants considered blood, cords, placentas, babies, and bodies as gross. When the informants got used to something, it was frequently no longer considered gross.

Things that are Scary at Birth

In the initial interviews the children mentioned things that were scary, such as the way mom breathed, the blood, and the way the baby looked. In subsequent interviews more folk terms were elicited.

The domains of meanings in "Things that are scary at birth" are shown in Figure 16. The following areas are viewed as scary things: mom during labor, mom during birth, death, uncertainty, blood, and the 178

Mom during mom not being ready to go into labor labor saying "What do I do now? " thinking she would be cut open on the stomach thinking mom was going to get hurt listening to sounds moaning of labor screaming and yelling mom not getting breathing real fast 'cause enough air her heart was getting less air sounding like she was losing her breath Mom during looking ugly and awful H birth fearing she'd lose too much blood PtZ M getting hurt and having to go to the hospital CQ having to get stitches H < Mom going to thinking too much blood would run out die more blood coming out Pi < when the most blood was coming out o CO thinking she wouldn't live all that much longer w thinking she would be cut open on the stomach Pi < Uncertainty baby would be born at home H didn't know what to do < not having anyone I could talk to or ask H questions of W o not knowing what was going to happen !S M afraid dad would have to help baby be born H dad not knowing what to do midwife not being there when my brother was going to get in the way hard to get to hospital on time thinking they didn't enow what to do going to the hospital not getting enough oxygen the first birth you see getting in the way cutting the cord thinking I was the only one that was scared it's awful for the person who has to watch

Figure 16. Domains of meaning in things that are scary at birth (continued on page 179) 179

Blood too much blood bleeding when water sac broke 33 H bleeding hurts ei M too much blood could run out of mom CO the blood can hurt H C the blood coming out you think the blood is never going to stop— 5J P3 only when there's no more left u to mom would lose too much blood and something w would happen to her 03 < The baby baby coming the way baby looks

Figure 16.—Continued 180

baby. Scary things involving the mother during labor and birth have

been discussed previously. The scary things of death, uncertainty

and blood, all related to the baby in some ways, are discussed in the

following paragraphs.

Death. It was not until the third and fourth interviews, when rapport was established, that cards containing folk terms belonging to

the domain "Things that are scary at birth" were presented to the key

informants. The folk terms were compiled from terms used by all the

informants. In the third and fourth interviews children began to talk about fears of mothers and/or babies dying:

Well, when I thought my mom would be cut open on the stomach I thought it would be scary because too much blood would come out and she would die. Well, I asked my mom after. I asked if any more blood came out would you die....I was just worried a real, real little bit. I really knew she wasn't going to die, but it sort of looked like it cause there was too much blood....My mom was hurting real bad and she could have gone to the hospital and she could have died and stuff like that (Hannah, 8 yrs. 2 mos.).

Hannah and Jane mentioned dying in relation to the uncertainty of see ing the first birth:

That's scary because I didn't know what was happening and it was going to happen and I didn't know if my mom was going to die or the baby was going to die (Hannah, 8 yrs. 2 mos.).

"Thinking baby was going to die"—which it wasn't.' That's one of the worst parts, especially if you've never seen a baby born (Jane, 8 yrs. 1 mo.).

Bret alluded to concerns about the baby dying by recalling a story about his own birth:

When I was born my mom said they had to hit me on the feet a couple of times to get me breathing. And if they couldn't have done that, I wouldn't be here, and Hannah would be the biggest kid (Bret, 10 yrs. 2 mos.). 181

Carl mentioned his thoughts about the baby dying as an example of the similarity between scared and worried: Well, worried and scared are pretty much alike. You're worried the baby's going to die and you're scared the baby's going to die. Same way (Carl, 11 yrs. 9 mos.).

When Carl sorted cards in the domain "Things that are scary at birth" he omitted the two cards about dying and commented:

"Thought mom was going to die"—I knew that wasn't going to happen. "Thought baby would die"—I thought he would be healthy (Carl 11 yrs. 9 mos.).

Uncertainty. Hannah's concerns about dying were framed in un certainty and not knowing. Her uncertainty was also apparent in com ments about other terms in "Things that are scary at birth":

"When mom say's what shall I do"—that's scary because maybe my mom won't know what to do and she'll do something that's wrong and it won't come out right. "Didn't know what to do"—I was scared about that because I didn't know like if I was going tp get in the way or if I was going to cause trouble. "When I didn't know what was going to happen"—I never saw it before and it just was real scary. "When the baby comes out"—that was scary because I didn't know what to do and maybe my mom didn't know what to do and maybe the midwife didn't know what to do, if it was her first time doing a baby. "Baby would be born at home"—I wasn't scared of that because it already happened, and it wasn't gross be cause we've done it before (Hannah, 8 yrs. 2 mos.).

It seems that just as things that are gross can be gotten used to, so can things that are scary.

With great consistency Bret maintained there was nothing that was scary at birth:

I just set my mind on what the baby would look like and how it would come out. I only had my mind fixed on two things.

He did admit that perhaps it was scary before the midwife arrived:

It was scary cause the "den mother (midwife) wasn't there yet and everything wasn't ready, and I was afraid the baby 182

wouldn't be born right and my dad would have to do it again (the father had unexpectedly delivered the previous sibling at an unplanned home birth). The baby could have come out, and my dad would have not known what to do (Bret, 10 yrs 2 mos.).

He was somewhat reassured by the fact that "mom knew what to do be cause she had four kids."

Some of the children had specific knowledge or experiences that they cited as part of being scared. Tanya was scared that her mom would have a cesarean section "cause this friend of ours—she had to get cut open because her baby was too big." Bret heard about "a lot of other ladies and babies who die because they take drugs or there isn't a doctor or midwife."

Two of the informants cut the umbilical cord following the birth. Carl said it was scary to cut the cord because of uncertainty about the blood:

My dad said: "Be careful, there may be a pile of blood coming—little higher—little lower—little higher—little lower." Finally I get in and I cut it, and I didn't want any blood squirting out, but there wasn't any (Carl, 11 yrs. 9 mos.).

Tony was the only other informant who cut the umbilical cord after the birth. He didn't talk about it, but Sherry, who was also at the Ortiz family birth reported:

I've never cut the cord myself, but it was neat at Mrs. Ortiz's birth cause they let Tony cut it. He didn't want to because he thought it was going to hurt her too. We ex plained to him, it doesn't hurt. There's no nerves in it, nothing that will cause any pain at all (Sherry 12 yrs. 5 mos.).

Blood. As with the domains of meaning in "Worst parts of being there" and Things that are gross at birth," blood was frequently cited 183 as being scary. Tanya said the most scary thing was "when blood keeps running out." I enquired if blood was always scary. Her response:

"No, but it's especially scary at birth." Tanya felt that the first birth was both gross and scary, but that by the second birth

...you wouldn't think it' s scary. Like if you saw the first one, and then you saw a second one, you wouldn't be as scared (Tanya, 7 yrs. 6 mos.).

Carl seemed to have "set his mind" on what to focus on at the birth in order to minimize the fear about blood. In response to the term "when the blood comes out" he said: "That's not what you come there to see—the blood coming out." Carl, trying to be honest and tough at the same time, said:

I'm used to blood since the birth. It doesn't bother me as much as it used to. It never really bothered me. It's part of life, but sometimes—(Pause)—it's sort of scary, but it doesn't bother all that much (Carl, 11 yrs. 9 mos.).

Other Scary Things. To add perspective to "scary" as used to describe birth, I asked the informants to tell me about other scary things in life (Figure 17). Other scary things, in addition to watch ing a baby being born, were things that made the children feel uncer tain or bad, and things that were life-threatening and thrilling.

With the use of contrast questions, the children told me about birth, as contrasted with other scary things:

One time on a roller coaster they left us upside down and it didn't even have seat belts. That's different. That's a carnival and this is a home. That's a machine. This is real. I was scared both times—about the same. Being scared at a horror movie is different, of course, yes. At a horror movie they're only pretending, like if they stab someone. But at birth if a baby didn't get enough oxygen, she'd die. Horror is a lot less scary. It isn't scary at all, except for my sister. She gets scared better (Bret, 10 yrs. 2 mos.). 184

Watching a baby be born Feeling being lost in a store uncertain seeing blood coming from your friend w going to a new school the first day tu H Feeling bad being sick in bed l-J nobody liking me !3 M not having friends cn people thinking I'm stupid O z breaking up with a girl friend H 32 asking a girl H getting married and parting from your parents >• 03 Life people trying to pick you up <3 O threatening people chasing after you w being trapped in the water Thrilling watching a horror movie being upside down in a roller coaster

Figure 17. Domains of meaning in scary things in life 185

Seeing a scary movie is the worst because I've seen blood a lot of times but I haven't seen scary movies very much be cause I don't like them. A horror movie is more scary than a birth (Hannah, 8 yrs. 2 mos.).

Seeing the blood at the birth would be worse than being lost in a store cause I know I can find my mom and dad cause I know they won't leave without me cause they always count the kids before they leave. If they don't find me, they go to the store manager (Hannah, 8 yrs. 2 mos.).

The description of "watching a baby being born" as scary or not depended on various factors: the child, the specific experience, past experiences, family support, and preparation. Jane commented: "It might not be scary for you, but it was for me." Carl maintained that watching a baby be born "isn't really that scary super much unless there are a lot of bad things happening."

Boundaries of "Scary." The boundaries of "Things that are scary at birth" and "Things that are gross at birth" seemed to overlap.

When all of the domain cover terms were presented to the key informants and they were asked which ones were most alike, they frequently selected

"Things that are gross at birth" and "Things that are scary at birth" as being most alike. However, they found it difficult to explain how they were alike or different. Informants used some of the same words to describe gross and scary, for example, "ugly," "bad" and "awful":

Well, when things are scary, well, it's just like when things are gross, but only sometimes when you're having a dream, and some things are scary, like a monster's scary. It looks gross, but there's not really a monster around (Jane, 8 yrs. 1 mo.).

Well, things that are scary make your heart beat faster, and things that are gross make you worry and go Ugh—GROSS. Gross things kind of make you feel like barfing (Carl, 11 yrs. 9 mos.). 186

One objective was to explore the boundaries of the domains

"Things that are scary at birth," and "Things that are gross at birth."

Some folk terms belonged inside the boundaries of the domains of mean ing because of similarities, and others belonged outside because of differences.

According to Spradley (1979, p. 157) one way to discover ex plicit and tacit cultural meaning is by using the contrast principle, that is, "the meaning of a symbol can be discovered by finding out how it is different from other symbols." Things that happen during three stages of birth" was a domain organized around the following stages:

(1) during labor; (2) during birth; and (3) after birth. The six key informants, all who were well-trained in the technique of card-sorting, sorted 55 cards with folk terms typed in large letters. The cards were placed into the six dimensions of contrast: (1) Things that are scary at birth; (2) Things that are gross at birth; (3) Worst parts of being there; (4) Things that make me worry; (5) Not gross or scary; and (6)

Both gross and scary. Not all terms were applicable or relevant to each child, in which case the card was set aside.

The dimensions of contrast between 55 folk terms for "Things that happen during three stages of birth" with six categories, according to six informants, is shown in Appendix F. Each X represents one girl informant and each 0 represents one boy informant who placed a particular folk term in one of the six categories.

The informants attacked the task purposively and enthusiasti cally, but they found it difficult to give me a rationale for their placement of cards in certain categories. Giving a reason required a 187

level of abstract thinking beyond some of the children. They were able

to sort concrete terms and give concrete examples of folk terms belong

ing in each category, but it was more difficult for them to compare and

contrast the abstract cover terms. When the informants were asked how

they decided to put certain cards in the categories, the following ex

planations were given:

Because things that I didn't want to see are the worst parts (Tanya, 9 yrs. 6 raos.).

Things that make me worry and worst parts are a little the same. Things that made me worry when my mom was in labor and worst part was not really scary and gross. It's not really gross. Some things weren't scary for me, and some things were. [How did you decide whether something was scary or gross?] Well, the way the baby looks is sort of scary (Jane, 8 yrs. 1 mo.).

Things that are gross and things that are scary are kind of the same cause they're gross, and scary is kind of the same as gross. Things that make me worry kind of goes with worst parts of being there. They're all kind of the same (Hannah, 8 yrs. 2 mos.).

Grant said gross things, scary things and worst parts seemed •

alike because "they're all bad things." He maintained there was noth

ing gross or scary for him and there weren't any worst parts. He and

Tanya both sorted the cards according to their ideas about how other children might feel. Grant placed 26 folk terms in the category

"Things that are scary." Most of the selected folk terms concerned bleeding, blood and hurting. When asked how he decided to put these terms in the scary category rather than gross category, he replied:

"Cause blood is scary, and if she loses too much she will die."

Sorting 55 folk terms was a demanding task, especially for one eight-year-old. By the last card she admitted her placement of "the 188 blood can hurt" in the category "Things that are both gross and scary" was a reflection of her desire to complete the task: "The blood can't really hurt. I just put it there because I wanted to get done." The informants seemed honest about their waning interest in research tasks and helped me gear the tasks to fit the attention span of their age group.

Patterns emerged when the six domains of meaning, (1) Things that are scary at birth; (2) Things that are gross at birth; (3) Worst parts of being there; (4) Things that make me worry; (5) Not gross or scary; and (6) Both gross and scary, were contrasted with the domain

"Things that happen during three stages of birth." The patterns de scribed in the following paragraphs were identified.

One pattern that emerged was things that are scary are found in all three stages of birth (during labor, during birth, and after birth). Scary things that happen during labor were primarily related to concerns about mom, scary things during birth were related to blood, and scary things after birth were related to concerns about the baby.

Things that are scary at birth were selected 60 times by the six infor mants, 29 by girls and 31 by boys.

The second pattern revealed gross things mostly happened in two stages of birth: during birth and after birth. Gross things during birth, like scary things during birth were related to blood.

Gross things after birth were related to the cord and placenta. Things that were gross were selected 31 times (13 by girls and 18 by boys by the six key informants). 189

Selected events considered the worst parts of being there

were found throughout the three stages of birth. The third pattern

revealed girls considered more events the worst parts than boys.

Forty-three events were selected as worst parts of being there by

girls and only five by boys.

The fourth pattern that emerged from sorting cards was that

the girl informants worried about more things related to the birth than

the boy informants. There were 14 selections, 10 by girls and 4 by

boys, of things that made them worry. Nine of the 14 choices were

things happening during labor. Worry was a word used on occasion by

some of the children: for example, "My mom, she started to have a

retraction, contraction I mean, and I started to worry (Bret, 10 yrs.

2 mos.). Jane (8 yrs. 1 mo.) was asked if she knew what "worried

meant": "Sort of. Like if you're riding a bicycle and you don't want to fall, you wouldn't ride it." When I asked the key informants

if there was anything that made them worry at birth, they all said

"No," except for Hannah, who said it took too long.

The fifth pattern that emerged showed that the things that were neither gross nor scary predominantly happened during labor, but were distributed unevenly through the three stages of birth: during labor (n=41), during birth (n=17) and after birth (n=20). The boys' choices (n=36) and the girls' choices (n=42) totaled 78 choices of things considered not gross or scary by the key informants.

The sixth pattern that emerged was that the few things con sidered both gross and scary were found primarily during the birth 190

itself, and all the things denoted as gross and scary were selected by

girls. Ten different things about birth were selected 11 times as

both gross and scary, with eight of these things happening during the

birth itself. The 10 things were considered gross and scary by the

three female key informants. The three male key informants did not

consider any of the things that happened during the three stages of

birth as both gross and scary.

In conclusion, the dimension of contrast containing the most

selections was "Not gross or scary" (n=78), followed by "Things that

are scary" (n=60) and "Worst parts of being there" (n=48). There were

definitely things that happen during the three stages of birth that

informants considered as scary and/or gross. These things usually in cluded blood, death, the cord and the placenta. Some of these events were also considered the worst parts of being there.

Things for Kids to Know about Being There

Some of the informants who witnessed childbirth recognized that

it was a learning experience for them. Jane and Bret considered the

learning experience as one of the best parts of being there. Some of

the comments from the children regarding their learning experiences included:

When you're there you can also learn a little more about how babies are being born if you've never seen a baby be born before (Jane, 8 yrs. 1 mo.).

Every kid should see their mom have a baby. It's neat. It's like school—you have to learn in school. You learn on having a baby. It's just like that (Bret, 8 yrs. 2 mos.).

If you ever have a baby you might be scared about some thing and it's really harmless (Hannah, 8 yrs. 2 mos.). 191

It always seems like I learn a LOT of things about birth. Ever since Paul was born, I've been learning things. But with every birth I find another question. And I ask my mom and she answers it (Sherry, 12 yrs. 5 mos.).

The domains of meaning in "Things for kids to know about being

there" (Figure 18) are a combination of things kids learned at birth and things kids should know about being there, according to 14 infor mants. Children need to know, what to expect at the birth, such as the characteristics of birth, all the main parts in a baby coming out, what all the words mean, such as contraction, placenta, Umbilical cord, uterus and ovary, what things look like, and that their mom will be OK.

The children did not agree as to what characteristics of birth should be presented to kids before the birth. For example, there was disagreement on whether or not kids should know it hurts a lot, whether or not there is a lot of bleeding, and whether or not birth is gross.

Kids should know how it's going to be, like if it's going to be gross or bad (Tanya, 9 yrs. 6 mos.).

They should not know it's gross, because if they think that it was gross they think their mom was some gross person because all of the blood and stuff like that because they'd probably only be seeing their mom. If they see their mom bleeding they might think "Oh my mom's going to die—she's losing blood." They might think that, so they should know (Bret, 10 yrs. 2 mos.).

It will scare them, and thinking about all the gross parts will make them feel sick. You mainly want to see the good things and learn. You could just tell them the gross parts, but try not to give them a super-super good picture of it. You got to tell them some parts are gross (Carl, 11 yrs. 9 mos.). 192

Characteristics it is gross of birth it is not gross there is blood there's not much blood mom has a lot of pain hard to get the baby out All the main how you have one parts in the the water sac breaks baby coming how it comes out out where the baby comes out What all the placenta words mean contraction umbilical cord w uterus 05 w ovary pa H What things placenta a look like cord 2 M a baby when it first comes out in true life

PQ Mom is OK it won't hurt your mom H bleeding won't hurt your mom ZD O if you bleed it won't kill you

Figure 18. Domains of meaning in things for kids to know about being there (continued on pages 193-94) 193

Rules on how don11 make a getting in the way to act problem goofing it all up (continued) making trouble sticking foot in water running into bucket of water scaring the midwife touching the midwife running into mom sticking hands by the baby getting germs on the baby don't make an being wiggly accident stepping on things w falling down 03 w bumping the midwife 32 H not helping your mom O don't be afraid don't feel scared and get J3 M real nervous W CQ keep your calm H stay calm O don't get excited CQ < don't panic don't be scared when the O 2 baby comes out don't get mom cares for the baby and o H jealous she still cares for you w babies need more attention o l-l than bigger kids—sometimes don't bug the making her lose her patience Pi o midwife crowding around her making her nervous o making her drop the baby's !z H head EC EH avoid scary and turning around gross things turning head closing eyes plugging ears going out of room fixing mind saying it doesn't matter don't crowd around baby right away Things that mom breathing happen fast water sac breaking baby slipping out baby popping out baby crying right after birth

Figure 18.—Continued 194

w Characteristics pull the balloon and the tube and it won't W of baby hurt when you cut it H if it stops breathing you give it air O don't let wet baby slip out of hands S M Having it at mom doesn't have to stay in the hospital w CQ home is baby doesn't have to stay in nursery H exciting O CQ <

O z o H 00 G

pi o

CO o s ffi H

Figure 18.—Continued 195

Carl and Bret were both rather pragmatic about the practical

lessons to be learned through witnessing childbirth. Bret thought

that children would be able to learn things, especially about bleed

ing, that would be applicable in other areas of their lives.

"Bleeding won't hurt your mom"—they should know that be cause they're going to bleed too, and it don't hurt you. Blood could come out of any living thing—well, not anything— people. If kids think that you bleed it will kill you, they won't play on the bars and be extra careful and they wouldn't get enough exercise (Bret, 10 yrs. 2 mos.).

Hannah was not concerned with the lessons to be learned by

children, but was uneasy about possible reactions of children if they

did not know what to expect, and consequently, behaved badly:

"Your mom won't die"—they should know that because maybe they think that their mom will die and they'll start crying and it will bother the lady that takes the baby out. "Don't make a problem"—cause it might goof it all up and the baby will come out with a broken leg or it might be crazy in the head (Hannah, 8 yrs. 2 mos.).

Paul was also concerned about how the behavior of children at

the birth scene could cause untoward consequences for other people who

were present:

Kids shouldn't feel scared and get real nervous cause it can get everybody else nervous, and then get the mom nervous. Nervousness can be contagious. You pass it on very quickly (Paul, 7 yrs. 10 mos.).

Hannah and Paul were able to consider how the behavior of children at birth could possibly effect other people and the baby, as interpreted within their culture of childhood.

The rules described by the children included ways to.help the mom, such as not bothering or tickling her, and ways not to "bug the midwife," such as not crowding around or making her nervous. The 196 children thought kids should know to sit still, be quiet and not touch anything.

The informants thought it was important for children to keep a low-profile at the birth scene: stay out of the way; don't make a problem; don't make an accident; and don't crowd around the baby. The informants also thought it was important to stay calm and not be afraid, which was considered by Bess as one of the things she learned:

I learned that you don't have to be afraid when a baby is born. You shouldn't think that a baby's hard to get out. [If your friends asked you about the baby, what would you tell them?] That you don't have to be afraid (Bess, 6 yrs.).

The "ideal" response of children to childbirth seemed to be re garded by the informants as not being afraid, scared, excited or nervous. Bret thought his calmness stemmed from having seen a movie about childbirth. Other children thought hearing explanations from their parents helped them the most to understand the birth:

I was real calm, because I saw a film on a baby being born. I knew what was going to happen. I didn't feel like crying at all (Bret, 10 yrs. 2 mos.).

I saw a movie about three girls who had their babies. I thought it would be real exciting. I think they should have their dad explain it and their mom explain it and look at picture books if you want, and see movies if they want; all of them except have friends tell you—cause the friends might tell you—I heard some of my friends told me the wrong thing and I believed them and it turned out wrong, and I believed them and got scared (Hannah, 8 yrs. 2 mos.).

See a movie ahead of time, so they don't think it's too gross or that she's dying or something. Kids should see a lot of things about a baby being born at first—cause the first one you see, if you don't see anything and they see the baby born at home, they may think, oh my gosh, and they may be scared and never want to do it (Carl, 11 yrs. 9 mos.). 197

Indeed, most children found some of the events of childbirth scary. Accordingly, the children thought kids should know what to do if birth was really scary or gross. Ways to avoid scary and the

gross things included turning around, closing eyes, plugging ears, going out of the room, and just saying there's nothing the matter.

These "real" behavior, as described by the informants, provided examples of specific actions used by them to cope with events that are considered scary and/or gross, from the child's-eye view.

"Things for kids to know about birth" included not getting jealous. When Paul was asked what he thought kids should know about birth, he responded:

Kids should know their mom is happy to have the baby and that she cares for the baby, and she still cares for you, and you shouldn't get jealous cause babies need more atten tion than bigger kids—sometimes, just not to get jealous of it (Paul, 7 yrs_^ 10 mos.).

In the adult world, sibling jealousy is considered a normative experience when a newborn joins a family. According to the litera ture, one parental motivation to include children at birth stems from parental desire to decrease sibling jealousy.

In the first several interviews none of the informants indicat ed that they felt replaced by the baby or sad about losing some of the parents' attention or gave any indication of jealousy. In order to stimulate comments about jealousy, a card for sorting "felt jealous of the baby" was .added to the domain "Worst parts of being there." It 198 was omitted consistently. Nevertheless, some informants volunteered information in response to the card:

I don't really feel like it (jealous), because my mom and dad done that to me too, cause I think she's really cute (Hannah, 8 yrs. 2 mos.).

I never feel jealous but my brother (5 years old) does sometimes. [How can you tell?] He doesn't get to hold the baby, and he and my sister (3 years old) fight over it, and she always gets to hold him (Grant, 7 yrs. 10 mos.).

I wasn't jealous or wasn't sad or nothing (Jane, 8 yrs. 1 mo.).

However, in an interview two months later she changed her mind. When asked if she ever felt jealous, she responded:

Like when the baby gets more attention than we do. Like the girls don't get attention, and the boys do because they're a lot younger than we are. [What do you do when you feel jealous?] I'm about ready to hit them—my brother, not my baby brother, but my big brother (4 years old). The baby gets a LOT more attention than my brother. We don't even get atten tion, me and my sister. And my brother only gets a little and the baby gets a lot. I'd like to be the youngest so I'd get more attention; but I really would like to be the oldest child, and the only child too. I could get lots of toys; I wouldn't have to worry about sharing a room; I wouldn't have to worry about getting punched by my brother. I wouldn't have to worry about holding the baby (Jane, 8 yrs. 1 mo.).

Grant and Tanya were aware of jealousy in younger siblings. In addition, Tanya admitted that she felt jealous of the baby "about one time every two or three weeks cause he gets more attention." It made her feel "like I just want to go to my room and stay there all day."

It happened when:

...like sometimes my dad says "Don't feel sorry for your self" cause I always get mad when they hold the baby. Mostly my brother (4 years old) gets jealous cause he always goes to his room, too, when he gets mad. He touches the baby and just flops his arm around and my mom does "D., stop it," and he 199

goes to his room. [What't the hardest part for kids with a new baby in the family?] When your parents get mad at you if you do something to the baby (Tanya, 9 yrs. 6 mos.).

Sherry talked about jealousy from the twelve-year-old's per spective. She remembered being jealous at five years of age when her first sibling was born, Seven years later she was able to verbalize how it felt, what caused it, what made her feel better, and how to avoid it.

I kind of felt left out. I thought the baby was just the greatest thing on earth, but to me, I felt kind of deserted. I was kind of mad at my mom and dad, and when they noticed that they started taking pictures and letting me hold the baby a lot. One of the main things (that made me feel better) was they were taking pictures of the baby AND ME together, and I like to take pictures. And then when T. (second brother) was born they handed me the baby almost as soon as he was born so I wouldn't get like that again. My mom was giving me things to do, and I felt like I was being useful. Before I just felt like a stump on a log (sic). I think the best thing to do is when the baby is born let them hold it and let them bring you the washcloth, a warm washcloth and show them how to get it warm, and show them how to kiss the baby without slobbering all over them. Show them how to love it and show them how to play with it, and through all the years how to • walk the baby and stuff (Sherry, 12 yrs. 5 mos.).

In conclusion, children, through watching, listening and spec ulating, acquire knowledge and learn the rules about how to interpret and how to behave at the culturally significant event of childbirth.. The culture of childhood seems to serve as a cognitive map, guiding the be havior of children at birth and their interpretation of the experience of being present at the birth event. This presentation of ethnograph ic data has described the six- to twelve-year-olds view of childbirth.

The categories discovered and analyzed were: (1) People who do things at birth; (2) Steps in a baby being born; (3) Things people do at 200 birth; (4) Best parts of being there; (5) Worst parts of being there;

(6) Things that are gross at birth; (7) Things that are scary at birth;

(8) Things that happen during the three stages of birth; and (9) Things for kids to know about being there.

Themes

Themes discovered from this study were derived from tying together bits and pieces of data collected from six-to twelve- year-olds regarding their view of childbirth. The themes were inferred from the recurrent messages found throughout the various domains of meaning. The themes were inferred after analyzing the data and searching for relationships and contrasts between the domains.

The themes represent the researcher's view of the structure which organized the informants' cultural knowledge which is used to interpret childbirth and inform behavior.

The identified themes include: (1) I never seen it before; (2) The first time you don't know; (3) It might not be scary for you, but it was for me; (4) The more often you see it, the less it bothers you; (5) Dads, kids and ladies help; (6) I can't stand to miss it; (7) It's kind of gross for the person who has to watch; and (8)

You learn by being there. Each of these themes will be discussed individually.

I Never Seen It Before

The first theme, "I never seen it before," was referred to indirectly by the informants throughout the interviews. The informants seemed to have a boundless curiosity for those events they had never seen before. In this study, the informants' curiosity was concentrated on "the baby coming out." "The baby coming out" was found in the domains "People who do things at birth," "Steps in a baby being born," "Things people do at birth," and "Best parts of being there." The various people who were involved with the baby com ing out included parents, children, practitioners and other helpers.

Children were included in the domain "People who do things at birth."

The stated reason from several informants regarding their presence at birth was: "I never seen it before."

The other domains of meaning related to the theme, "I never seen it before," included "Things that are scary at birth" and "Things for kids to know about being there." One of the scary things for the informants at birth was the baby coming out, which was also the event that triggered the children's curiosity. "All the main parts in the baby coming out," was also one of the things for children to know about being there. The informants did not know about the birthing pro cess in detail, because children primarily learn about birth by being there. Except for one informant, one of the children had ever "seen it before."

Even though many informants had observed birth in childbirth education films and/or on television, the opportunity to actually be present "to see the whole birth" for the first time was something they couldn't "stand to miss," which was another theme implied from the data obtained from the informants. The informants were drawn to 202

events that were unusual and rare events from their perspective. They

didn't want to miss anything that was new, which included many things

at the birth scene; for instance, things the mothers were doing, such

as the way they were breathing, making noises and have contractions,

the way the babies looked when they first came out, and seeing the

cord and placenta.

Informants preferred not to watch something they had seen be fore if there was something else that was new to see—for example, choosing not to watch breast feeding if the placenta was coming out.

Their curiosity shifted to what they considered the most rare and un

usual event. In another comparison, if a rare event, such as a trip in a space trip to Mars were available, childbirth became more common, and at least one informant would have chosen the trip to Mars. Their enthusiasm for experiencing new things was accompanied by an uncertain ty which was expressed in the second theme, "The first time you don't know."

The First Time you Don't Know

The second theme, "The first time you don't know," was implied in the uncertainty felt by the informants due to their own inexperience, and, at times, their doubts about the capabilities of their moms, dads and midwives. This theme related the domains of "Things people do at birth," "Worst parts of being there," and "Things people do at birth." The fear of not knowing was generalized by some informants:

"Maybe no one will know what to do."

The first time the child or someone else participates in birth

"you don't know," and that's scary. For instance, the first time 203 children don't know how long it will take; they don't know all the rules for how to act, like staying out of the way, being quiet, and not making a problem. These phrases are found in the domain "Things for kids to know about being there."

Along with the uncertainty for children of not knowing what will happen the first time they see a birth, there is also the strong enticement to see the event as expressed in the first theme, "I never seen it before." As children gain experience in an area, the uncertainty diminishes, which is related to the theme "The more often you see it, the less it bothers you."

Feelings of uncertainty stemming from not knowing were ameliorated in some instances by being told ahead of time, seeing a movie, and/or seeing blood from injuries at other times. But, as one informant commented about his mother's explanation: I didn't under stand, so I wanted to see the baby be born."

It Might Not be Scary for You, but It was for Me

The third theme, "It might not be scary for you, but it was for me," implied children have their own view of birth, which might differ from an adult view. This theme was related to another theme,

"The first time you don't know." For instance, some informants con sidered their mothers experienced at having babies, and, therefore, did not feel uncertain about their capabilities. If it was the first time for the fathers and midwives to help, the children considered it scary, because "the first time you don't know." 204

Many factors influenced what the children considered scary. . For example, specific experiences were scary for certain children: a rush- trip to the hospital in the middle of the night or an explosive bag of water in the middle of a contraction. There were other more subtle scary events, like mom saying: "What shall I do?," which was part of the domain "Worst parts of being there." Other domains of meaning related to this theme, "It might not be scary for you but it was for me," are "Things that are scary at birth," "Things for kids to know about being there," such as "you don't have to be afraid," and the "Dimen sions of contrast in things that happen during three stages of birth."

The More Often You See It, the Less It Bothers You

The fourth theme took the form of an assertion: the more often you see something, the less it bothers you. The informants were referring to "getting used to it," a desensitization process that happened when they were exposed to gross and scary things, which in this study, was the cultural scene of childbirth.

Gross and scary things were described by the informants and are found in the domains of meaning: "Things that are gross at birth," and "Things that are scary at birth." Things to which the children were desensitized included the birth in general, and blood, the mother's body and the placenta specifically. The theme, "The more often you see it, the less it bothers you," is related to other themes, such as "I never seen it before," and "The first time you don't know." With experience you gain knowledge, and then things bother you less. 205

Dads, Kids, and Ladies Help Mom

The fifth theme implied that mom had a very difficult task which required and deserved the assistance of dads, kids, and midwives. This theme was related to the other themes of "The first time you don't know," "It might not be scary for you, but it was for me," "It's kind of gross for the person who has to watch," and "I can't stand to miss it." The relationships between themes are represented in a "push/pull" dichotomy. There was a strong "pull" to stay with mom and help her, even though there was the "push" of dreading the uncertainty and the gross and scary things. The outcome of this conflict for all of the informants was expressed in the cul tural theme, "I can't stand to miss it."

I Can't Stand to Miss It

The sixth theme, "I can't stand to miss it," was implied by the informants in the domain, "Best parts of being there." Clearly a high light for these six-to twelve-year-old informants was watching the baby emerge and having immediate contact with the baby.

The theme of "I can't stand to miss it" was, in some ways, in cultural contradiction with other themes, such as "The first time you don't know," "It might not be scary for you, but it was for me," and

"It's kind of gross for the person who has to watch." The children resolved this conflict by "just standing it," telling themselves "it dosen't matter," and "fixing their mind" on the reason they were there, that is, to see the baby be born, not to see the blood, and other gross and scary things. 206

The informants did not want to miss anything, especially if they had never seen it before. An urgency not to miss the birth was accented by the belief that maybe you could see it only once because

"my mom isn't going to have any more babies" and "most mothers don't want to share their births."

It's Kind of Gross for the Person Who has to Watch

The seventh theme. "It's kind of gross for the person who has to watch," implied there were gross things at birth that were es pecially apparent when one was in the role of an observer, partic ularly if one were a first time observer. This theme emerged from the domains "Things kids do at birth" and "Things that are gross at birth."

Observations made by children when they were present at birth included a number of things they considered gross, such as, blood, the mother's body, the baby, cord and placenta.

The theme, "It's kind of gross for the person who has to watch," was related to several other themes, such as "I never seen it before," "The first time you don't know," "The more often you see it, the less it bothers you," and " I can't stand to miss it."

Even though things were considered gross, often because it was the first time to see something like blood coming out of "the privates," the informants all chose to watch.

You Learn by Being There

The final theme, "You learn by being there," was derived from all of the domains, but chiefly from the domain "Things for kids to know about being there." This theme implied that first-hand experi ence was a great teacher. This theme was, in some respects, the mediating theme between apparent cultural contradictions. For ex ample, "You learn by being there" was a mediating theme for the cul tural contradiction regarding bleeding and the possible consequence of death. The informants learned that, to some degree, bleeding will hurt neither their mothers at birth nor themselves in other situa tions.

"You learn by being there" is also a mediating theme between several themes that stand in opposition to one another. These opposing themes exert a "push/pull" force on the informants in regard to their presence at the birth scene. The themes that assert a

"pull" on the child to be present at birth include "I never seen it before," "The more often you see it, the less it bothers you," "Dads, kids and ladies help," and "I can't stand to miss it." The opposing themes that exert a "push" on the child away from the birth scene include "The first time you don't know," "It might not be scary for you, but it was for me," and'"It's kind of gross for the person who has to watch." The tension between these conflicting themes is re solved in the final theme, "You learn by being there."

Summary

Characteristics of the sample and the presentation and analysis of the ethnographic data, including the details of the inter views and drawings, were described in this chapter. The ethnographic data were displayed in domains of meaning: (1) People who do things at birth; (2) Steps in a baby being born; (3) Things people do at birth, which included domains of meaning for moms, dads, kids, midwives and babies; (4) Best parts of being there; (5) Worst parts of being there; (6) Things that are gross at birth; (7) Things that are scary at birth and in life; (8) Dimensions of contrast in things that happen during three stages of birth; and (9) Things for kids to know about being there. The ethnographic statements revealed the child's-eye view of childbirth. The domains of meaning demonstrated the structure of the cultural knowledge used by six-to twelve-year-olds to interpret their childbirth experiences and inform their behavior.

Eight themes were abstracted from the ethnographic data which were elicited from six-to twelve-year-olds: (1) I never seen it before; (2) The first time you don't know; (3) It might not be scary for you, but it was for me: (4) The more often you see it, the less it bothers you; (5) Dads, kids and ladies help; (6) I can't stand to miss it; (7) It's kind of gross for the person who has to watch; and (8)

You learn by being there. The relationships of the themes with the domains of meaning were discussed and the interrelationships between the themes were inferred from the ethnographic data by the researcher. CHAPTER 7

CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the conclusions and recommendations drawn from the study of childbirth through children's eyes. The categories for discussion include themes and the research questions, themes and the background of the study, themes and the guiding per spectives, themes and health care, recommendations for future study, and the conclusion.

Themes and the Research Questions

The major questions that guided this study were: (1) What is the six-to twelve-year-old child's view of childbirth? (2) How do children conceptualize birth in contemporary American culture? and (3)

What factors influence children's participation at childbirth? The research questions were addressed through use of the ethnographic method. Cultural knowledge was elicited from 14 informants. This knowledge informed their behavior and gave meaning to their world, specifically to their experience of being present at childbirth.

The cultural knowledge of the six-to twelve-year-old infor mants regarding childbirth is represented in the eight themes that have been abstracted from the ethnographic data. The eight themes include: (1) I never seen it before; (2) The first time you don't know; (3) It might not be scary for you, but it was for me; (4) The

209 210 more often you see it, the less it bothers you; (5) Dads, kids and

ladies help: (6) I can't stand to miss it: (7) It's kind of gross

for the person who has to watch; and (8) You learn by being there.

These eight themes provide the answer, in part, to the

question: What is the six-to twelve-year-old child's view of child

birth? To summarize the eight themes that answer this question, the

six-to twelve-year-old informants who have been present at childbirth view childbirth as gross and scary, particularly the first time, but don't want to miss being there to see, to help and to learn.

The eight themes also provide the answer, in part, to the

second research question: How do children conceptualize birth in contemporary American culture? To summarize the eight themes that answer this question, the informants conceptualize birth as a family event that triggers curiosity, uncertainty, and fears. Birth is assumed by the informants to belong in the world of childhood. Ac cording to two informants: "Seeing it is one thing that every kid should see done," and "Most people don't want to miss their mom having a baby, so most kids get to watch."

The third research question: What factors influence chil dren's participation at childbirth is concerned with the processes that affect children's experience with childbirth. The answer to this question is based on the ethnographic data and also on the character istics of the informants and their families. Factors which affect children's participation at childbirth include the time of day the 211 birth occurs, the preparation of the child, the family style of shar ing events, emotional atmosphere in the family, the parents' attitude about sexuality and childbirth, patterns of childrearing, the coping abilities of the parents and children, the support of significant people such as grandparents, neighbors, and practitioners, previous experiences of children regarding birth or traumatic events involving blood, and the curiosity level of the child. Other factors such as age, gender, educational level, cognitive ability, developmental stage, and location of birth are of interest, but they play a minor role in influencing the capability of children to participate in childbirth.

However, they do affect the preparation and plans that must be made to prepare and care for children at the time of birth.

Themes and Background of the Study

The sibling experience is very common and long lasting. Eighty percent of American children grow up in a family context that includes siblings (Mussen et al. 1974). Siblings are being included at child birth as more and more families choose alternative styles of birthing: using midwives, selecting home or birthing center as the location for birth, and including people who care about the mother and baby, such as children in the family.

In order to study the child's view of childbirth it was essen tial to consider the culturally sensitive nature of the topics of sexuality and birth. Even though some individuals have hesitated to speak about these topics, the children in the present study, as in the Kreitler and Kreitler (1966) study, were eager to talk in spite of the personal content of the answers to the ethnographic questions.

Kreitler and Kreitler (1966) recognized the importance of obtaining the child's view, rather than making decisions about children's par ticipation at birth devoid of an empirical base.

The Interprofessional Task Force on Health Care of Women and

Children (1978) maintained that childbearing events have potential as a developmental opportunity and/or a situational crisis for family mem bers. Maturational gains could be made by children during the time of pregnancy and childbirth, according to Bibring (1959), who viewed childbearing as a "normal crisis." The themes generated in this study indicated that the six-to twelve-year-old informants considered child birth as both a developmental opportunity and a situational crisis.

Childbirth as a developmental opportunity was expressed in the following themes: (1) I never seen it before; (2) Dads, kids, and ladies help; (3) I can't stand to miss it; and (4) You learn by being there. Childbirth as a situational crisis was indicated in the following themes: (1) The first time you don't know; (2) It might not be scary for you, but it was for me; and (3) It's kind of gross for the person who has to watch. The remaining theme, "The more often you see it, the less it bothers you," communicated aspects of birth as both a situational crisis, and as a developmental opportunity. This theme expressed the view of children that parts of birth are worrisome, but familiarity with childbirth decreases the perplexing and distressing nature of birth. 213

The children communicated a sense of urgency in taking advan

tage of the opportunity to witness childbirth, as implied in the

following themes: (1) I never seen it before; (2) I can't stand to

miss it; and (3) You learn by being there. These themes supported

the statement by Bernstein and Cowan (1975) that not knowing can be

upsetting to children. The informants wanted to see childbirth and

to learn by being present. The reality of childbirth seemed less

distressing as children gained experience.

In their research on the origin of babies, Bernstein and Cowen

(1975) learned that children construct notions about babies and birth

without waiting to be told. Many of these notions might be "incorrect"

but harmless and, in time, become more accurate. However, birth might

be conceptualized in a way that needlessly remains an on-going concern

or develops into adult fears about birth.

Goldman and Goldman (1982) have found that when children operate

in a knowledge or experience void, they construct their own explana

tions. Children's explanations about childbirth have recently become

medical in nature. Instead of a powerful and mysterious stork bringing

babies, children now envision powerful doctors and nurses functioning

in a mysterious hospital. Children who have not witnessed birth tend

to have fantasy ideas about the infant's arrival and remain puzzled and mystified in spite of information made available to them (Mehl

et al. 1977). One informant in the present study has indicated the relevance "being there" had to his understanding of birth: "...I 214

wondered how—at first I thought, do they cut your stomach open and

then sew it back. How do they get out?—until my mom told me, but

then, well, I didn't really understand, so I wanted to see the baby

be born."

Sex information is taken in (accommodated) and assimilated

"on the basis of the child's experience, affect, and cognitive struc

tural level (Bernstein and Cowan 1975, p. 90)." Children at different

ages and children who have different experiences at childbirth will

understand birth in different ways, as they assimilate and accommodate

information that fits their stage of cognitive development. Bernstein

(1978) concludes that knowing the child's view enables adults to make

appropriate explanations in order to enhance the process of accommoda

tion and assimilation regarding information on human reproduction.

Being present at birth becomes an experience in the child's repertoire

to assist with future accommodation and assimilation of information

regarding childbirth.

Mehl et al. (1977) noted that six-to twelve-year-olds were

afraid of blood and some turned away from it. According to the

Hathaways (1978), one of the concerns of children was the amount of

blood. There was a similar finding in the present study communicated

in the themes, "It's kind of gross for the person who has to watch,"

and "It might not be scary for you, but it was for me." Both of these

themes emerged, in part, from ethnographic data in the domains of

meaning "Things that are scary at birth" and "Things that are gross at

birth." One category contained children's ideas of "ways to avoid scary and gross things," which included turning away from blood. 215

Through drawings and verbalizations of children, Anderson

(1981b) found children were eager and enthusiastic about participating in childbirth. This finding was supported in the present study by the themes, "I never seen it before," and "I can't stand to miss it," which primarily referred to witnessing the infant emerge from the mother.

The eagerness of six-to twelve-year-olds to see the baby come out was related to seeing something for the first time. The school age children were concerned about the mother, but their enthusiasm was about the baby, which was in contrast to the primary interest of preschool children, who focused on their mothers during childbirth

(Mehl et al. 1977, Fragner 1979).

Informants' interest in the newborn might be significant in terms of sibling bonding, a unique attachment made during the fourth stage of labor. One informant indicated a special affection devel oped during the birth. She made a picture card and wrote inside:

"M. You are cute. I saw you being born. I love you."

Anderson (1981b) also found' that six-to twelve-year-old chil dren were eager to assist with simple tasks. This finding was sup ported in this study by the theme, "Dads, kids and ladies help," which, according to Erikson (1950), corresponds with the stage of in dustry versus inferiority seen in six-to twelve-year-old children.

The Hathaways (1978) considered witnessing childbirth as a way to learn to help and a method of positive sex education. Both were implied by the theme that emerged in the present study, "You learn by being there." According to the Hathaways (1978), other concerns of kids, along with the blood, were the baby's crying and the mother's exposure. This present study found similar concerns about the baby, and, in some cases, about seeing the mother's body. These concerns of children appeared in the domains of meaning and were inferred in

the themes: "It might not be scary for you, but it was for me," and

"It's kind of gross for the person who has to watch."

A research team at Mt. Zion Hospital Alternative Birth Center

(ABC) in San Francisco studied several issues regarding sibling attendance at childbirth. The parental motivations were categorized into three groups: (1) against hospitalism; (2) for family affilia tion; and (3) against sibling rivalry (Ballard et al. 1982). In the present study, informants' responses to the question about the reasons their parents wanted to include them at childbirth were not similar to the motivations of the parents in the Mt. Zion study. Informants thought their parents wanted them to be present at birth primarily to see and to learn, as well as other practical considerations, such as the lack of a babysitter. There was no evidence that informants con sidered broader adult issues, such as control of who is allowed to be present at birth, humanizing the experience, family affiliation, and/or sibling attachment, to be relevant to their own reasons for wanting to be present at childbirth, or to their parents' reasons for including children.

The Mt. Zion research team also concluded that childbirth is primarily an adult event, and that when children are present it is 217 on account of parental wishes (Leonard et al. 1979). The findings in the present study, as expressed in the themes, "I can't stand to miss it," "Dads, kids, and ladies help," and You learn by being there," did not support the conclusions drawn from initial observations of behavior of 40 children ranging in age from three to fourteen years who attended birth at the Mt. Zion Hospital ABC. In the present study, six-to twelve-year-old children were eager to participate at birth. The were allowed to be present because of parental wishes, but the enthusiasm to "see everything" came from the children's curiosity and inquisitiveness.

Accessibility of childbirth to children has been a taboo in many cultures, although certainly not a universal taboo. In the United

States some parents have been purposively breaking the taboo excluding children from childbirth. Only in the last decade have children been included at birth to any extent. The inclusion of children at child birth in contemporary American culture has usually followed a conscious decision by parents to allow children to be present, as well as some kind of formal or informal preparation of the children for childbirth.

Intentionally including children at birth contrasts with the information in the review of the cross-cultural literature presented in Chapter 3. As indicated in the literature reviewed, children are allowed access to childbirth for various reasons: through intent, as with the Araucanians; through circumstance due to living space, as found among the Jamaicans: or because of children's curiosity, as 218 noted among the Aranda. However, no description is found in the literature regarding formal preparation of children for birth events.

Children, through time and space, have been present at childbirth, but the recent practice in Western culture of preparing and deliberate ly including children at childbirth has occurred concomitantly with the family-centered childbirth movement and the attempts of parents to control some aspects of childbirth, for instance who is allowed to be present at birth.

Themes and Guiding Perspectives

The themes and the guiding perspectives of this study will be discussed in this section. The concepts which have guided this study include: (1) childbirth as a sociocultural event; (2) culture of childhood; (3) child's-eye view; and (4) cognitive development. Child birth is conceptualized as a significant life-cycle event that is socially organized and culturally shaped. The meaning of birth for adults and children is woven into the fabric of society and influences how birth is conceptualized, for example, as natural, healthy, open, and respectful or as unnatural, unhealthy, private and shameful. The nuroberous ways in which childbearing is patterned are primaily dic tated by the ways in which the group defines the birth event (Mead and

Newton 1967).

Even though the practice of including children at birth is cul turally shaped, the specific decision of whether or not to include chil dren occurs within the family unit whose primary objective is to promote 219 the physical, mental and social development of each family member (Clark and Affonso 1976). Some of the themes, such as "I never seen it before," and "You learn by being there," imply that birth is viewed as a developmental opportunity. Other themes, such as "The first time you don't know," and "It might not be scary for you, but it was for me," imply that birth is stressful for children due to experiencing un certainties and confronting fears. Concern about the stressfulness of birth for children undoubtedly influences parents who must decide the appropriate role of children in regard to childbirth.

Children have their own view about birth which they generate out of their own personal, social and cultural material (Goodman 1970).

The children's views of their experiences comprise the culture of childhood. Children, through watching, listening and speculating, acquire cultural knowledge which is used to interpret birth. The children's cultural knowledge includes the rules about how to behave at the birth event. The informants' cultural knowledge regarding childbirth is communicated through the domains of meaning from which the themes have been inferred. The views of six-to twelve-year- old children on birth are based in the culture of childhood. Accord ing to Goodman (1970, p. 117), "inherent curiosity is surely as natural to children in tribal as in modern urban societies." Themes that speak to the curiosity in six-to twelve-year-olds are "I never seen it before," and "I can't stand to miss it." Goodman (1970, p. 9) believes that curiosity is a powerful factor related to attention and learning, and that it is "in the nature of man from birth." 220

The child's eye view refers not only to what the child sees,

but also to the attached meaning. This study presents what children

describe they see when they observe childbirth, rather than what

adults see when they observe children. The child's view at times

resembles the adult view, and at other times emphasizes content be

longing only to the world of the child, which may result in dis

crepancies between the two views, as communicated in the theme, "It

might not be scary for you, but it was for me." This theme indicates

that children do not think or feel about birth in the same way as

adults.

Children bring to the birth experience their own individual

perspective, the influence of parents and the culture of childhood.

Out of their experiences, children generate cognitive patterns that

are both similar to and different from those of their peers, family

and society. Thus, not all the informants agree on the meaning of all

of the culturally relevant folk terms, such as bleeding. Nevertheless,

themes emerged that indicate the construction of children's cognitive

map of childbirth, such as "It's kind of gross for the person who has

to watch." The cognitive map gives insight to how children interpret

childbirth.

The child's cognitive map is built in the process of cognitive

development (Piaget 1973). Therefore, children's concepts of birth

are continually altering with progression in experience and cognitive ability. Progression in experience and cognitive ability influence

how children communicate their views of childbirth. Because of the 221

level of cognitive, language and drawing development of the six-to

twelve-year-old informants, it has been possible to elicit folk terms

and domains of meaning from the verbalizations and pictures of the

children.

Themes and Health Care

This study has implications for nursing practice as well as for

individuals who provide health care to childbearing families. In

addition, this study illustrates how the ethnographic approach can be

utilized in research which is relevant to nursing practice.

Children's view of childbirth, as communicated through the

themes, is of interest to health professionals who provide anticipatory

guidance to childbearing families and who facilitate the participation

of children at childbirth, according to each family's choice. The

themes provide health professionals with insight into children's views

of childbirth and the culture of childhood, and thereby enhance the

understanding of children's behavior generally and in regard to child

birth specifically. The cultural knowledge of children portrayed in

the domains of meaning and in the themes provide a framework for

administering family-centered care to all family members during child-

bearing events.

Parents and health professionals can better help children

integrate the concept of birth into their lives if adults know chil

dren's views and how much the children can cognitively understand

(Perrin and Gerrity 1981). Understanding children's views of child

birth in order to care for the childbearing family fits within the 222

nature and scope of nursing historically and recently, as defined by

the American Nurses' Association (1980, p. 9): "Nursing is the diag nosis and treatment of human responses to actual or potential health

problems." Human responses that are the focus for nursing interven

tion include: "Strains related to life processes, such as birth, growth and development, and death (American Nurses' Association 1980, p. 10)." Eight themes have been identified in this study. These

themes provide information about the strains children experience in association with both birth and development. Nurses identify one of the goals of nursing is the amelioration of conditions that present a strain to individuals, families and communities. Strains to families, parents and children are anticipated at the time of birth.

It is important for health professionals to appreciate that parents might need and want additional help before the birth in ex plaining childbirth to children and in comprehending birth as a developmental opportunity and a situational crises. During the birth ing event, the obstetrician,, and even midwives to a lesser extent, focus primarily on the laboring mother; the pediatrician is available for the newborn; and the nurse is the health professional whose role is to provide care and comfort to all the family members. Osborne

(1969) refers to this conceptualization of total patient care or family-centered nursing as the generalizing nature of nursing. The nurse monitors the childbearing event from a family perspective, and thus also has responsibilities toward participating children. 223

Nurses and midwives are presently involved with conducting sibling preparation classes at various hospitals and birthing centers across the country. The following suggestions, based on the eight themes that have been identified in this study, are made for the preparation of "expecting siblings" and for the facilitation of par ticipation of children present at birth. Many of the suggestions can be carried out by parents in the home setting and/or by health profes sionals in the home, clinic, birthing center or hospital setting.

Children are especially curious about and at times feel uncer tain about unfamiliar things. This has been expressed in the theme, "I never seen it before," which refers to the birth process in general as well as to specific things. Unfamiliar things include amniotic fluid, blood, placenta and umbilical cord, and also other things such as mom's body, health monitoring equipment, sterile glpves, and pelvic examination. It is beneficial to introduce children to many of these things before the birth. This can be done by including children in prenatal examinations. At that time the children can meet the health caregivers and become familiar with equipment, such as the ultrasound stethoscope. Children can listen to the fetal heart beat and can watch the practitioner assess the mother and fetus through palpation and measurement of the abdomen and examination of the pelvis.

These experiences will familiarize children with "Things people do at birth." The children will also become acquainted with their mother's body. Nurses can suggest to mothers who are concerned about modesty, that they be less private about bathing, dressing, and undressing in order to familiarize their children with the appearance of their body. 224

Books, birthing dolls, puppets, the child's own baby book, films, slides, videotapes, preferably in color, can also be used to gradually introduce the child to things they have never seen before to help relieve the strain implied in the theme "The first time you don't know." Many hospital obstetrical units now provide tours of birthing rooms for children. Nurses' have an opportunity to acquaint children with a health system that helps a healthy mother give birth to a healthy baby. The health system also has the capabilities to care for the mother and infant if they become ill, which might reassure the child about fears of the mother or infant dying. Families con sidering the inclusion of children almost always consider birth as a natural occurance and anticipate little medical intervention. Mothers must usually be assessed as "low-risk" by health professionals in order to include siblings in their birth plan.

Classes for siblings usually familiarize children with the steps in a baby being born and the sights and sounds of labor and births: (1) the facial expressions and the sounds of labor, which can be simulated, indicating pain and hard work; (2) the wetness of birth, such as breaking of the bag of water and the blood; (3) the positions assumed by the mother, which might look strange; (4) the painless cutting of the umbilical cord, like cutting fingernails and hair; (5) the appearance and capabilities of the baby, with special attention to the color changes of the baby; (6) the appearance and function of the placenta. A fresh placenta or a thawed frozen placenta can be used to show how the blood travels through the umbilical cord to the baby. 225

Children can put on gloves and explore the placenta. This activity can serve to desensitize children to the presence of blood at birth, and also acquaint them with the idea that bleeding is not always dangerous and painful.

The importance of sensory experiences, in addition to verbal descriptions, to acquaint children with the sights and sounds of labor and birth, are implied in the theme, "The more often you see it, the less it bothers you." Johnson, Kirchhoff and Endress (1975) have found that congruency between expected and experienced physical sen sations during a threatening experience results in less distress. By knowing the child's view of distressing events at birth, preparation classes can focus on presenting information on what is seen, heard, smelled and felt while observing childbirth. Such classes would decrease the discrepancy between "the expected" and "the experienced," and possibly decrease the distress experienced in the situational crisis of birth, and enhance the developmental opportunity inherent in birth.

The theme, "Dads, kids, and ladies help," implies that some six-to twelve-year-old children not only want to be present, but also envision a role for themselves. Simple tasks can be delegated to children, such as bringing cool cloths, providing a drink, walking with mother or giving her a massage. Older children might play the mother's favorite records or tapes and take pictures or movies. Every effort should be made to include children at birth if the parents and children so choose. It is disappointing for children to look forward 226

to the birth, and then be excluded. Of course, the unknown elements

of birth are always present, and possible alterations in the birth

plan should be discussed with the children.

The theme, "I can't stand to miss it," implies that children

will be disappointed if they miss the birth, specifically the emerging

newborn. The informants consistently select "watching the baby

coming out" as the best part of being at birth. Some institutions

allow children's visitation during labor and post-partum period, but

exclude them from the birth itself. Perhaps such policies, meant to

"protect" the child, serve instead to increase the intensity of birth

as a strain on the child and decrease the opportunity for developmental

and maturational gains for the child. In addition, being present gives

children an opportunity to see, touch, stroke, and eventually hold the

baby. Such an opportunity allows the children time to identify the

uniquenesses of the newborn and to begin establishing a relationship

and bridging the gap between their fantasies and reality.

The domains of meaning in "Things for kids to know about being

there" (Figure 18) outline a lesson plan provided by enculturated chil

dren who have been present at birth. The informants suggest children know: (1) the characteristics of birth, which includes blood and pain;

(2) all the main parts in the baby coming out; (3) what all the words

mean; (4) what things look like; (5) that mom is OK; (6) rules for how

to act, like staying out of the way, not making a problem, and not

being afraid or jealous; (7) things that happen fast, such as the water

bag breaking and the baby slipping out; and (8) characteristics of the 227 baby. Children who are advocates of home births also think children should know that it's exciting to have a baby at home.

Two themes, "It might not be scary for you, but it was for me," and "It's kind of gross for the person who has to watch," indicate the importance of preparing children for: (1) things children consider gross at birth, such as some parts of the body, blood, the color of the baby, the cord and placenta; and (2) things children consider scary at birth, such as concerns about mom during labor and birth, specifically thoughts of death, uncertainties of not knowing, and concerns about blood and the baby. Things that are considered gross and scary by

V children can be discussed before the birth using books, pictures, movies and doll play, and can also be a subject for further discussion after the birth.

Debriefing children in the days following the birth might in clude drawing pictures of the birth, writing stories, and sharing news with other family and friends. Children can re-experience the best parts and worst parts of birth by rereading books on birth in light of their own personal experiences, playing with birthing dolls and look ing at pictures of the birth. Such follow-up activity can consolidate the things children learned by being there.

Nurses have the opportunity to provide wholistic care to fam ilies during childbearing events. For instance, nurses can: (1) pro vide family-centered care to the entire childbearing family, including fathers and children; (2) teach parents and children about pregnancy, the birth process and caring for newborns; (3) communicate that birth is a normal and natural event that occurs in the context of family 228

life; and (4) encourage family affiliation during childbearing events

through an attitude that conveys not only the importance of physical

care to mother and infant, but also the significance of wholistic

care to the birth of a new family. Nurses will have a greater

understanding of the significance of childbearing to the whole family

if they: (1) consider the sociocultural influences on birthing

practices; (2) conceptualize birth as both a developmental opportunity

and a situational crisis for individuals and families; and (3) under

stand the unique views children have of birth. Familiarity with

children's views of childbirth provides the foundation to enable health

professionals to assist parents in preparing their children for the

common universal experience of childbirth and becoming a sibling. The

way in which children are prepared for and interpret childbirth may have far-reaching implications for their own later attitudes toward childbearing, families, male and female roles and sibling relationships.

Recommendations for Future Study

Qualitative research, in addition to being descriptive, has a responsibility to identify variables and to generate research questions and specific hypotheses that lend themselves to further study.

The following research questions can be raised:

(1) What is the relationship between children's per ception of birth and demographic data, such as age, gender family constellation and so on?

(2) How do children at different ages and in dif ferent cultures conceptualize birth? (3) What is the correspondence between actual behavior of children at birth and their statements about birth?

(4) What is the parents'-eye view of birth events which include children?

(5) What is the relationship between prepar- tory classes for children and level of distress experienced by children at child birth?

On the basis of this study, the following recommendations for future research are suggested. The first recommendation for future study is to investigate how the psychological dimensions of children's perceptions, such as birth as "scary" and "gross" and feelings of un certainty and fear about death, correlate with various dependent vari ables. An instrument could be constructed to measure variables that have cultural and psychological relevance to children in relation to childbirth. The ethnographic data make it possible to develop a scale with items clearly worded from the child's view that are unbiased by adult perceptions of children's concerns. Concepts that have been identified in the themes, such as scary, gross, uncertainty, curiosity, getting used to it, helping and learning can be incorporated into scale items. The quantitative data then can be correlated with dependent variables, such as age, gender, ethnicity, family constellation, type of preparation for birth, birth experience, location of birth, and type of support available for children. Such a study can be longi tudinal in design to determine the long-term effect that being present at birth has on the child's view of birth through the years. 230

A second recommendation for further study is to stage chil

dren's conceptualization of birth in different age groups according

to Piagetian levels of cognitive development. Exploring stage-related

development of birth concepts is a recent area of study (Bernstein and

Cowan 1975, Goldman and Goldman 1982). It parallels the extensive

investigation of stage-related development of children's concepts of

death. Stage-related development of children's concepts of birth can be investigated in populations of children who have been present at

birth, as well as in those who have not been present at birth.

A third recommendation is to pursue the question of cross-cul tural similarities and differences in the way birth is conceptualized by children. A comparative study, using one or more cultures, can compare and contrast children's views of childbirth with those of six-to twelve-year-olds in contemporary American culture, as well as with other age groups. Because of the common universal nature of birth, the child's view of childbirth lends itself to discovering con ceptual and behavioral variability during childhood across cultures and within cultures.

A fourth recommendation is to combine the ethnographic methods of participant observation and ethnographic interview to study the child's-eye view of birth for all ages of children in order to yield knowledge about the culture of childhood. Participant observation is a valuable method to use with children in the preoperational stage of development (approximately two to six years of age). The method of participant observation allows the investigator to look beyond reports 231

of behavior and to observe the behavior directly. Using both obser

vation and interview allows the investigator to assess the correspon

dence or the discrepancy that exists between the real and ideal

cultural statements (Ragucci 1972). In addition to combining the

ethnographic methods of observation and interview, a methodological

recommendation for future studies with children includes using pictures

for card-sorting with pre-reading children who are able to classify.

For children in the concrete operational stage of development (ages 6

to 11) with skills in classifying and comparing, rating questions

could be used to discover the values placed on sets of symbols

(Spradley 1979).

A fifth recommendation is to do a similar descriptive study

as the present study with mothers and fathers whose children are pres

ent at birth in order to establish the parent's-eye view of the cul

tural birth scene which includes children. Nurses can use ethnographic

approaches to discover how individuals, patients and professionals con

ceptualize such things as birth, death, health, illness and healing.

A sixth recommendation for future study is to test the following

hypothesis: Children who attend preparatory classes including descrip

tions and simulated experiences of physical sensations of the sights and sound of labor and birth will display and describe less distress

in being present at childbirth. A similar hypothesis has been tested by Johnson, Kirchhoff and Endress (1975) regarding children's distress behavior during orthopedic cast removal: "The hypothesis tested was that discrepancy between expected and experienced physical sensations 232

(what is felt, seen, heard, tasted, and smelled) during a threatening

experience will result in distress (Johnson et al. 1975, p. 404)."

There is support for the hypothesis that a preparatory message de

scribing sensations children experience during orthopedic cast removal

will reduce distress during cast removal. Preparation which includes

description of typical sensations experienced during a distressing

event increases the accuracy of expected sensations and decreases in accurate expectations. "The theoretical hypothesis that congruence between expected and experienced physical sensations results in a reduction of emotional response during a threatening experience has been supported in several situations and age groups (Johnson et al.

1975, p. 409)," but this hypothesis has not yet been tested regarding

preparation of children for childbirth.

Conclusion

This chapter has discussed the eight themes as they relate to

the research questions, the background of the study, the guiding per spectives and health care. Childbirth has been conceptualized by six-to twelve-year-olds as a family event that produces uncertainties and fears, and triggers curiosity.

The themes indicate that, from a child's view, birth is both a situational crisis and a developmental opportunity. The delineation of the child's view of childbirth provides knowledge to assist health pro fessionals and parents in preparing children for birth and facilitating the participation of children at birth. This knowledge supports the applied science of nursing by providing a framework for understanding the individual and family responses to the strains that accompany childbirth. Nurses' awareness of the child's view and the importance of sensory experiences can aid nurses in preparing parents and their children by enhancing the congruency for the child between "the expected" and "the experienced" at the birth event.

Several recommendations have been described for future re search, such as the construction of a quantitative instrument to mea sure variables that emerged from the ethnographic data, the investigation of stage-related development of children's concepts of birth, cross-cultural studies, the combination of participant obser vation and ethnographic interview, descriptive studies with parents, and the testing of a hypothesis regarding the use of descriptive and simulated experiences to prepare children for childbirth. A nursing goal for the entire childbearing family is to minimize the situational crisis of birth and enhance the developmental opportunity that accompanies the birth of a baby and the birth of a family. APPENDIX A

ACCESSIBILITY OF CHILDBIRTH TO CHILDREN IN

50 CULTURAL UNITS WITH OUTLINE OF WORLD

CULTURES (OWC) CODE

234 APPENDIX A

ACCESSIBILITY OF CHILDBIRTH TO CHILDREN IN 50 CULTURAL UNITS WITH OUTLINE OF WORLD CULTURES(OWC)CODE

(Cultural units marked with an asterisk are included in the Murdock Sample of 150 cultural units).

World Cultural OWC Access to Publication Area Unit Code Birth Variable Practices Ethnographer Date Asia *Ainu AB6 Yes Pilsudski 1910 *Lepcha AK5 Yes Gorer 1938 Morris 1938 Laos AM8 Yes Young Males Reinach 1901 "Malaya ANL Yes Sons wait nearby Djamour 1959 Winstedt 1922 ^Central Thai AO 7 Yes Hanks 1963 '•Burmese AP4 Yes Girls visiting laboring Brant 1954 women. Orr 1951

Africa *Chagga FN4 No Gutmann 1926 *Pygmies F04 Yes Turnbull 1965 *Azande F07 Yes Small boys assist. Seligman 1932 Anderson 1911 *Bushmen FX10 No Lebzelter 1934 *Zulu FX20 Yes Access to young boys Raum 1973 and girls. Pubescent boys and girls for bidden. APPENDIX A—Continued

ACCESSIBILITY OF CHILDBIRTH TO CHILDREN IN 50 CULTURAL UNITS WITH OUTLINE OF WORLD CULTURES(OWC)CODE

(Cultural units marked with an asterisk are included in the Murdock Sample of 150 cultural units).

World Cultural OWC Access to Publication Area Unit Code Birth Variable Practices Ethnographer Date North '•Copper Eskimo ND8 No Rasmussen 1932 America Hare ND9 No Hara 1964 *0jibwa NG6 No Hilger 1951 Montagnais NH6 No Lips 1947 Henriksen 1973 --Arapaho NQ6 No Hilger 1952 *Crow NQ10 No Lowie 1935 Dhegiha NQ12 No Dorsey 1882 *Hopi NT9 No Voth 1905 Talayesva 1942 Eggan 1950 *Navaho NT13 Yes/No Conflicting data Dyk 1938 Lockett 1939 Bailey 1950 *Zapotec NU44 Yes Messer 1975 Tzeltal NV9 No Nash 1970 Mam NW8 No Wagley 1941 APPENDIX A—Continued

ACCESSIBILITY OF CHILDBIRTH TO CHILDREN IN 50 CULTURAL UNITS WITH OUTLINE OF WORLD QPLTURES(OWC)CODE

(Cultural units marked with an asterisk are included in the Murdock Sample of 150 cultural units).

World Cultural OWC Access to Publication Area Unit Code Birth Variable Practices Ethnographer Date Apayao 0A5 Yes Access to girls, not Vanoverbergh 1936—i boys "Alor 0F5 Yes DuBois 1944 *Bali 0F7 Yes Covarrubias 1938 '•Toradja 0G11 Yes Adriana & Kruyt 1951 ••Aranda 018 Yes Schulze 1891 Wogeo OJ27 No Hogbin 1943 *Kapauku OJ29 No Pospisil 1958 "Manus 0M6 No In 1930 Mead 1930 Yes In 1956 Mead 1956 *Buka 0N6 Yes Blackwood 1935 *Lau-Fiji 0Q6 Yes Thompson 1940 *Marshalls 0R11 Yes Gather near birth hut Kramer & 1938 Nevermann *Truk 0R19 Yes Gladwin & 1953 Sarason Kramer 1932 *Yap OR22 Yes Lingenfelter 1971 *Pukapuka 0Z11 Yes Beaglehole & 1938 Beaglehole APPENDIX A—Continued

ACCESSIBILITY OF CHILDBIRTH TO CHILDREN IN 50 CULTURAL UNITS WITH OUTLINE OF WORLD CULTURES(OWC)CODE

(Cultural units marked with an asterisk are included in the Murdock Sample of 150 cultural units).

World Cultural OWC Access to Publication Area Unit Code Birth Variable Practices Ethnographer Date Russia Gilyak RX2 No Pilsudski 1910 "Chukchee RY2 No Bogoraz-Tan 1904-9

II South *Cuna SB5 No Nordenskiold 1938 America Stout 1947 Marshall 1950 *Goajiro SC13 Yes Forbidden in certain Bolinder 1957 geographical regions de Pineda 1950 Cayapa SD6 Yes Altschuler 1964 Murra 1948 *Siriono SF21 Yes Holmberg 1950 *Araucanians SG4 Yes Forbidden in certain Titiev 1951 groups. Faron 1961 Hilger 1957 *0na SH4 No Gusinde 1931 *Yahgan SH6 Yes Young girls help. Very small girls and Gusinde 1937 boys excluded. *Yanoama SQ18 Yes Barker 1953 *Bush Negroes SR8 Yes Kahn 1931 Puerto Rico SU1 Yes Landy 1959 Jamaica SY1 Yes Kerr 1952 Cohen 1952 APPENDIX B

PARENTAL CONSENT FORM

239 240

APPENDIX B

PARENTAL CONSENT FORM

I understand that I am consenting for my child to take part in a research project on the meaning of sibling birth to children. The project is designed to learn about children's ideas about birth before, during, and after the birth of a new brother or sister. My family was selected to participate in this study because my child plans to be present at the birth.

My child will be observed and interviewed at three points in time: 1) during two or more visits to our home in the third trimester of the pregnancy; 2) during the birth event (labor and delivery); and 3) during one or more visits to our home in the first month following the birth. Each home visit will last approximately 60-90 minutes. The observations and interview during the birth will be made when the child is present or in the nearby vicinity of the labor and birth.

The questions will generally attempt to elicit the child's point of view about childbirth. A tape recorder and notes will be used to collect data. My child will also be asked to make two drawings both before and after the birth, which will be kept by the researcher.

I understand that there are no physical discomforts or risks to me or my child, and that all information received will be anonymous and in no way will names or addresses be used. I realize that if I do not agree to participate in this project that the health care for me or my family will not be affected in any way.

I understand there is no monetary payment involved with par ticipation, and there is no cost to me. The benefit will only be indirect by generally increasing the understanding about sibling(s) and childbirth. All records will be kept strictly confiden tial in an area restricted to the researcher and authorized representatives of the University of Arizona College of Nursing.

The project has been explained to me, and I understand that I am free to ask questions and withdraw from the project at any time. 241

I understand what the participation of my family involves, and I agree that my child will be part of the project, understanding that I may see the results of the study at its completion.

Parent's Signature

Date APPENDIX C

CHILD CONSENT FORM

242 243

APPENDIX C

CHILD CONSENT FORM

I am asking you to help me with a research project about what children think and feel when a baby is born into a family. I will talk with you several times within the next two months for about an hour each time. I will visit with you, ask you to talk into a tape recorder, and to draw pictures. I will keep your pictures, and will write about what you tell me, but I will not use your name. I will also be with you when your baby brother or sister is born. By learn ing from you what it's like when a baby is born in your family, other people can understand children's ideas about birth.

You can decide if you want to do this or not. If you do, you can still stop anytime you choose. There is no known reason that this will hurt you in any way. You will not need to pay money, nor will you be paid. You may ask any questions you like at any time. You don't have to answer any questions you don't want to.

You may keep a copy of this form. I am asking your parents to read this and sign it too. When they do this it means they think you understand what I have said and that it'sail right with them too.

I understand what has been written in this consent form. What it means has been explained to me and to my parents. I know that I may ask questions and that I may stop at any time. I under stand that this consent form will be kept in a safe place in the University of Arizona College of Nursing, and that only the re search people may see it.

Child's Signature Date

I believe that my child understands what he or she has signed

Parent's Signature Date APPENDIX D

SELF-REPORTED DEMOGRAPHIC PROFILE OF 14

INFORMANTS AND THEIR FAMILIES WITH

PSEUDONYMS

244 APPENDIX D

SELF-REPORTED DEMOGRAPHIC PROFILE OF 14 INFORMANTS AND THEIR FAMILIES WITH PSEUDONYMS

(Six key informants are marked with an asterisk).

Name of Family Age in Education Family Members Years/Months in years Occupation Ethnic Group Religion Redding Mother 25 14 Homemaker Caucasian Protestant Father 31 15 Roofer Caucasian Protestant -'Tanya 9 yrs. 6 mos. *Jane 8 yrs. 1 mos. Boy 4 yrs. Boy Newborn Landon Mother 32 13 Housewife Caucasian Latter Day Saints Father 33 19 Lawy&r Caucasian Latter Day Saints *Bret 10 yrs. 2 mos. '•Hannah 8 yrs. 2 mos. Boy 4 yrs. 11 mos. Girl 3 yrs. 5 mos. Girl Newborn f Strauss Mother 38 16 Homemaker White Lutheran Father 44 19 Car * White Lutheran Salesman *Carl 11 yrs. 9 mos. "Grant 7 yrs. 10 mos. Boy 5 yrs. 8 mos. Girl 3 yrs. 5 mos. Boy Newborn APPENDIX D—Continued

SELF-REPORTED DEMOGRAPHIC PROFILE OF 14 INFORMANTS AND THEIR FAMILIES WITH PSEUDONYMS

(Six key informants are marked with an asterisk).

Name of Family Age in Education Family Members Years/Months in years Occupation Ethnic Group Religion Moreno Mother 41 16 Teacher Anglo Presbyterian Father 36 14 Brickyard Mexican Catholic Manager Melinda 6 yrs. 8 mos. Girl 7 yrs. 4 mos. (Step-sister) Boy Newborn Thomas Mother 30 11.5 Homemaker Anglo Reborn of the Spirit Father 30 15 Building Anglo Reborn of Maintenance the Spirit Sherry 12 yrs. 5 mos. Paul 7 yrs. 10 mos. Boy 4 yrs. 11 mos. Girl 2 yrs. 9 mos. Girl 8 mos. APPENDIX D—Continued

SELF-REPORTED DEMOGRAPHIC PROFILE OF 14 INFORMANTS AND THEIR FAMILIES WITH PSEUDONYMS

(Six key informants are marked with an asterisk).

Name of Family Age in Education Family Members Years/Months in years Occupation Ethnic Group Religion Ortiz Mother 27 11 Housewife Mexican-American Christian Father 29 12 Roofer Mexican-American Christian Tony 9 yrs. 2 mos. Manuel 6 yrs. 11 mos. Girl 2 yrs. 8 mos. Girl Newborn Deanne 9 yrs. 3 mos. (Cousin) Lupe 11 yrs. (Cousin) Conner Mother 28 12 Housewife/ Caucasian Jehovah's Mother Witness Father 33 12 Commercial Caucasian Jehovah's Painter Witness Bess 6 yrs. Boy 4 yrs. Boy Newborn APPENDIX E

INFORMANTS' DRAWINGS

248 249

LIST OF ILLUSTRATIONS

Figure Page

E-l. Mom on the birth chair . 250

E-2. Mom feeling happy 251

E-3. Dad comforting mom 252

E-4. Trying to pull it out 253

E-5. And the baby is born 254

E-6. Waiting for the baby to come 255

E-7. We all helped 256

E-8. The head is coming out 257

E-9. Holding the baby 258

E-10. Mommy having the baby 259

E-ll. Blood is coming out 260 Figure E-l. Mom on the birth chair

This is my mom sitting on the birth chair. That's how she had to hold her legs up. The head is coming out. The midwife is pulling the baby's head out. There's a bowl with a wash cloth (Hannah, 8 yrs. 2 mos.). Figure E-2. Mom feeling happy

This is when my mom was resting and feeling happy. The baby is with dad. I am playing a little game, Rubic's Cube. This is a kind of flower on my mom's paper. Do you see the pattern in the flowers? (Melinda, 6 yrs. 8 mos.). If

Figure E-3. Dad comforting mom

The baby is coming out. Dad is comforting mom on the couch (Carl, 11 yrs. 9 mos.)(The informant identified the other figures: three brothers on the left side of the couch, including the informant holding a cam era; two family friends, one making a videotape; a three-year-old sister; and the midwife and her assistant). 253

Figure E-4. Trying to pull it out

Mom is having the baby and dad's trying to pull it out. Mom's very happy cause she's having a baby. Dad's on his knees squatting down. He takes the legs...oh, ya, he takes the baby's arms first, and then the legs (Paul, 7 yrs. 10 mos.). Figure E-5. And the baby is born

In this story, the mother is in labor. In this story the dad is helping the mom. The sister is watching. The younger sister is watching and brother is clapping. And the baby is born (Jane, 8 yrs. 1 mo.). Figure E-6. Waiting for-the baby to come

•4 Dad is ready to catch the baby. I am waiting for the baby to come and mom is just having a contraction. She is doing rhythmic breathing (Sherry, 12 yrs. 5 mos.). 256 i rth

Figure E-7. We all helped

The midwife was trying to find the baby in my mom's stom ach. Me and Hannah are waiting anxiously, wondering about the color of the eyes and hair and if it is a boy or girl. Mom is trying really hard not to push. Dad is helping her not to push. The midwife said: "Push a lit tle." My dad was helping real good too. The midwife's helper was waiting to cut the cord so the baby could come all the way out. On her next contraction, the midwife said that the placenta would come out, and after the pla centa came out, the helper asked where the bags were and I helped her put the placenta in three bags so we could put it in the trash or under a tree. I helped the mid wife take the chair apart and put it in her car (Bret, 10 yrs. 2 mos.)(The informant explained that the four circles represent the four siblings, and the mother is sitting on a birth chair). 257

Figure E-8. The head is coming out

Mom is on the bed. The baby's head is coming out. There is a quilt at the foot of the bed (Bess, 6 yrs.). 258

Figure E-9. Holding the baby

Morn is holding the baby in bed. Me an Manuel are there (Tony, 9 yrs . 2 rnos.)(The informant explained that on the right side of the picture is the father and the two year-old sister who sat with him in the living room watching TV during the birth. The grandma and grandpa were corning through the door. They are "corning to hold the baby) . " 259 E ~ ~ ~ ~ ,_~ ) ~ ~

~ ~ ~ ~ 0 L ~ ~ ~~ ~

Figure E-10. Mommy having the baby

I'm standing watching my mom. My sister is watching my mom. My brother is holding his blanket. Dad is grabbing my mom's wrist. She's gritting her teeth because she has pain. The baby was purple. They laid him on her tummy. It was gross (Tanya, 9 yrs . 6 mos.). 260

Figure E-11. Blood is coming out

The baby is coming out. The head is in the middle with black hair, and blood is coming out (Lupe, 11 yrs.). APPENDIX F

DIMENSIONS OF CONTRAST IN THINGS THAT

HAPPEN DURING THREE STAGES OF BIRTH

261 APPENDIX F

DIMENSIONS OF CONTRAST IN THINGS THAT HAPPEN DURING THREE STAGES OF BIRTH

(Each X represents one girl informant rj=3. Each 0 represents one boy informant n=3). Things that Happen during Three Dimensions of Contrast Stages of Birth Things Things Worst Things Not Both that that parts of that gross gross DURING LABOR are are being make me or and scary gross there worry scary scary Mom not ready to go into labor X 0 X Boring to wait with nothing to XX X 00 do Waiting for the baby XX X 00 Waiting for contractions 0 XX X 0 Mom saying "What shall I do?" X 0 X 0 Not knowing what to do XX X 0 Not knowing what is going to X 0 0 X 0 happen Mom screaming 0 0 X X Mom moaning 0 0 XX 0 X Seeing mom's body 0 XXXO Seeing all the privates 0 X 0 X The vagina getting bigger and 0 X 0 XX bigger Mom on hands and knees 0 XXXO Being cut 0 X X Thinking mom would have to be 0 ,x X cut open on the stomach APPENDIX F—Continued

DIMENSIONS OF CONTRAST IN THINGS THAT HAPPEN DURING THREE STAGES OF BIRTH (Each X represents one girl informant n=3. Each 0 represents one boy informant n=3). Things that Happen during Three Dimensions of Contrast Stages of Birth Things Things Worst Things Not Both DURING LABOR that that parts of that gross gross (Continued) are are being make me or and scary gross there worry scary scary Must have hurt really bad 0 XX X Mom breathing real fast 0 X XX 0 Mom not getting enough air X 00 X 0 Thinking mom was going to die X 0 X X Thinking baby wasn't going to XX 0 X X 0 come out Baby would be born at home 0 X XX Getting in the way X Not having anyone I could talk 0 X XX 0 to or ask questions Thinking I was the only one X X 0 that was scared

DURING BIRTH

The first birth you see X X 00 X It's awful for the person who 0 X X has to watch Do-do and blood and all that X 00 X coming out APPENDIX F—Continued

DIMENSIONS OF CONTRAST IN THINGS THAT HAPPEN DURING THREE STAGES OF BIRTH (Each X represents one girl informant n=3. Each 0 represents one boy informant n=3). Things that Happen during Three Dimensions of Contrast Stages of Birth Things Things Worst Things Not Both DURING BIRTH that that parts of that gross gross (Continued) are are being make me or and scary gross there worry scary scary The blood can hurt X 0 X Blood was running out 0 XX X Bleeding when water sac broke X 00 X X So much blood 0 X X Too much blood 0 0 X X X Afraid mom would lose too X 00 X X much blood If more blood comes out XX 00 X she'll die Blood keeps running out X 00 0 XX Blood makes me sick X X 0 X Blood makes me almost barf X X 0 X Bleeding hurts 0 X X X 0 X Someone moving in your way 0 XX X 0 so you can't see Worrying younger brother or X 0 XX 00 sister would get in the way Baby comes X 00 X APPENDIX F—Continued

DIMENSIONS OF CONTRAST IN THINGS. THAT HAPPEN DURING THREE STAGES OF BIRTH (Each X represents one girl informant n=3. Each 0 represents one boy informant n=3). Things that Happen during Three Dimensions of Contrast Stages of Birth Things Things Worst Things Not Both that that parts of that gross gross AFTER BIRTH are are being make me or and scary gross there worry scary scary So much blood after the baby XX 0 X comes out Seeing the cord X 0 X X Cutting the cord 0 X 0 X : X 00 Seeing the placenta X XX 0 00 Touching the cord or placenta XX 0 X 0 Looks ugly 0 X X X 0 Looks ugly and awful X X 0 X X The way baby looks XX X The baby is blue or purple X X 00 Midwife could have dropped X 00 X X the baby's head Thinking baby had a disease X 0 X Thinking baby was going to die XX X Thinking baby would take my X X 00 place in the family Mv camera didn't work X X 00 REFERENCES

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