Learning to Birth, Mastering the Social Practice of Birth: Conceptualising Birthing Women As Skilful and Knowledgeable Agents
Total Page：16
File Type：pdf, Size：1020Kb
Learning to birth, mastering the social practice of birth: conceptualising birthing women as skilful and knowledgeable agents Johanne Dagustun Submitted in accordance with the requirements for the degree of Doctor of Philosophy The University of Leeds School of Geography April 2017 The candidate confirms that the work submitted is her own and that appropriate credit has been given where reference has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. © 2017 The University of Leeds and Johanne Dagustun The right of Johanne Dagustun to be identified as Author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988. ii Acknowledgements For introducing me to the subject of geography, I thank Mr Moss. Many good geography teachers and lecturers have followed him, but Mr Moss played a key role in launching my commitment to the discipline. Peter Jackson shared the task of tutoring me through my undergraduate degree at University College London and later set me on this doctoral path. I am grateful for his encouragement. Debbie Phillips provided me with a very warm welcome when I first arrived in Leeds and I have been fortunate to benefit from her ongoing commitment. Despite moving to Oxford some years ago, Debbie has continued, alongside Nichola Wood, to skilfully and patiently supervise my studies. Promoted to main supervisor along the way, Nichola has demonstrated excellent skills in keeping me happily to task: I will miss our coffee skypes, during which Nichola offered much kind encouragement. Thanks to them both, as well as to the members of my research support group at the University of Leeds - David Bell and Louise Waite (School of Geography) and Kuldip Bharj (School of Healthcare) – and to my examiners – Kye Askins (University of Glasgow) and Myles Gould (University of Leeds). This thesis would not have been prepared without the financial support of the Economic and Social Research Council. I am grateful for their 1+3 funding and the flexibility it has offered, including part-time study. Thesis citations are inevitably partial, and so I also acknowledge here the impressive, and influential, wider body of scholarship that did not make it to the final cut. Whilst I have often found the task of producing this PhD thesis a solitary one, many colleagues, friends and family members have helped in its production. Thanks in particular to my mum, who provided a high-quality transcription service, to my friends Vikki and Miriam for the very practical help provided, to my two longstanding midwife friends, Mandie and Tina, who have offered unstinting encouragement as I have ‘trespassed’ on their territory, and to many others, met at gatherings and conferences along the way, who have proved to be a highly supportive community of scholars. My partner, David (with the help of Gousto and Hello Fresh!), and children, Ellie, Gulliver, Clara and Laramie, have all too, each in their own way, helped me along the way: thank you to them. Finally, without participants there would be no primary data to underpin this study: a huge thanks to all of the women who shared their childbirth stories with me. iii Abstract In this thesis, I draw inspiration from Bourdieu’s theory of practice to inform a conceptualisation of birthing women as skilful and knowledgeable agents. The study contributes to geographical knowledge about spaces of birth and about how these represent key sites of learning. Empirical data were collected in 2011/12 through in- depth semi-structured interviews with 26 women living in North-West England (involving 68 childbirth experiences). Two key themes emerged from the women’s narratives: the prevalence of trouble (and how this is accepted as ‘just the way things are’) and routine (and non-medically indicated) diversions from an undisturbed physiological birth process. This thesis argues that rather than representing a space in which women might learn to protect the physiological process of birth, successive experiences of birth seem to represent a space in which many women learn to shut down that possibility. Rather, they prioritise defensive action to protect themselves against emotional and physical harm, with some women learning that a physiological approach to birth is unnecessary, abnormal and dangerous. Whilst there is evidence that some women learn to birth physiologically over their childbearing careers by drawing on their experiential knowledge, the main finding is that being skilful and knowledgeable as a birthing woman frequently works in the opposite direction. The study thus offers new understandings of birthing women as skilful and knowledgeable agents and explores the diversity of women’s learning about birth by drawing a distinction between how women come to master the social practice of birth and how they learn to birth physiologically over their childbearing careers. For the wider academy, this study brings a renewed emphasis on the key role of childbearing women in the social practice of birth. iv Contents Acknowledgements .................................................................................... iii Abstract ....................................................................................................... iv Contents ....................................................................................................... v Chapter 1 Introduction ................................................................................ 1 1.1 Research beginnings ....................................................................... 3 1.2 Positioning the researcher ............................................................... 4 1.3 Identifying study objectives .............................................................. 5 1.4 Structure of the thesis ...................................................................... 8 Chapter 2 Birthing women as skilful and knowledgeable agents: a literature review ................................................................................... 9 2.1 Childbirth, spaces of childbirth and the geographical imagination.... 9 2.1.1 Early engagements: fertility as a key component of population geographies........................................................ 11 2.1.2 Childbirth as a site of injustice: national, local and networked perspectives ....................................................... 12 2.1.3 Developing a disciplinary interest in the diverse spaces of childbirth .............................................................................. 13 2.1.4 Further disciplinary contributions (1): productions of physiological childbirth ......................................................... 17 2.1.5 Further disciplinary contributions (2): productions of medicalized birth practice .................................................... 19 2.1.6 Geographical scholarship on the practice of birth: a summary .............................................................................. 20 2.2 Power, agency, knowledge: but where is the birthing woman? ...... 22 2.2.1 Understandings of birth and the role of the birthing woman 22 2.2.2 Improving birth for women and babies: the focus of health scholarship ........................................................................... 26 2.2.3 Exploring the marginalization of the birthing woman in the context of organisational learning literature ......................... 29 2.2.4 Conceptualisations of women as skilful and knowledgeable agents: the role of antenatal education and learning beyond the classroom ............................................ 33 2.2.5 The role of women’s knowledge and agency in relational models of care: from knowledge learnt from others to knowledge based on embodied experience ......................... 37 2.3 Conclusion ..................................................................................... 39 v Chapter 3 Putting Bourdieu to work in the birthroom: developing a conceptual understanding of the social practice of birth .............. 40 3.1 Conceptualising experiential learning: drawing on geographies of education and learning ................................................................ 41 3.2 Conceptualising social practice: Bourdieu in human geography .... 43 3.3 Bourdieu: conceptualising illusio and habitus as key to social practice ........................................................................................ 44 3.3.1 Understanding social practice, recognising skilful and knowledgeable agents ......................................................... 45 3.3.2 (Habitus x Capital) + Field = Practice.................................. 46 3.3.3 Social practice: playing the game with intuitive mastery ..... 48 3.3.4 Illusio and investment: experiencing the world through the games in which we get caught up ........................................ 49 3.3.5 Conclusion .......................................................................... 50 3.4 Existing Bourdieusian scholarship on birth .................................... 50 3.4.1 Bourdieusian perspectives on the organisation of maternity care ...................................................................................... 51 3.4.2 The practice of birth and the birthing women: Bourdieusian perspectives......................................................................... 52 3.4.3 How are birthing women conceptualised in Bourdieusian