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CENTRE FOR SOCIAL SCIENCE RESEARCH Choosing Care: Negotiating and reconciling interference in narratives of home births Nicole Miriam Daniels CSSR Working Paper No. 340 July 2014
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CENTRE FOR

SOCIAL SCIENCE RESEARCH

Choosing Care: Negotiating and

reconciling interference in narratives of

home births

Nicole Miriam Daniels

CSSR Working Paper No. 340

July 2014

Published for the Centre for Social Science Research

University of Cape Town

2014

http://www.cssr.uct.ac.za

This Working Paper can be downloaded from:

http://cssr.uct.ac.za/pub/wp/340/

ISBN 978-1-77011-327-5

© Centre for Social Science Research, UCT, 2014

About the author:

Nicole Miriam Daniels is a Masters student at the University of Cape Town

Acknowledgements:

The write up of this paper was made possible by generous financial assistance from the Centre for Social Science Research. I am indebted to the participants of this

study who were willing to invite me into their homes to share in their intimate encounters with home birth. Deeply touched by their narratives, I offer this work, in

thanks to you.

Dedicated family, friends & fellow aspirants, too numerous to name, provided

carefully crafted support for and welcome relief from this project. Peter, Ajualuna and Zara patiently afforded me the space to think, write and freak-out about this work. They teach me the measure of life’s mistakes, acknowledged and made with love,

that both undo and remake’s the hearts capacity to love even further still.

Finally, my supervisor Dr Elena Moore’s unfettered contributions to my honours research and this working paper have been invaluable. Please accept my heartfelt

thanks for your encouragement, criticisms, and belief in me. None of this was possible without you. You are the edge!

1

Choosing Care: Negotiating and reconciling interference in narratives of home births

Abstract

While the literature on home birth emphasises women’s capacity to relate to

birth in deeply meaningful terms, less attention has been paid to ‘interferences’

in this process. The extent to which women’s birthing needs are met relates to

their capacity to make meaningful birth choices. By drawing on four case

studies of South African home birthers, this paper examines the kinds of care

which generate a sense of containment and continual relationship for birthing

women, despite interference. Where home births validate and affirm the psycho-

social nature of relational birthing subjects; being supported, being seen and

being heard, translates into a social environment of care. Subjective

interpretations of what matters most, narrated by home birthers in relationship

with partners and caregivers, describe social environments which uphold safety,

intimacy, connection, and agency. Homes are not controlled environments, so

the inconsistency between narrated birth and actual birth experiences offers an

interesting vantage point on the social contexts that generate empowered

birthing selves. The care afforded home birthers allows them to create and

maintain safe birth spaces, even as homes - bridges of public/private divides -

intrude on relational selves. This research adds to an understanding of the

consequences of women’s birth choices. By foregrounding interference, this

paper highlights that choices (contested as they are) remain fundamental to

women’s experiences of birth.

Introduction

The rhetoric of ‘choice’ as a well-established concept in the childbirth literature

has proved controversial in feminist debates championing women’s rights (see

Annandale and Clarke, 1996; Beckett, 2005; Chadwick, 2007). Not only has the

justification of ‘choice’ proven itself confined to the benefits of privileged

women, but its adoption by both the alternative birth movement and the pro-

caesarean movement exhibits defunct grounds from which to argue for women’s

birthing liberation (Beckett, 2005: 263). Women choosing to birth at home,

known to be middle to well-off, with higher education qualifications (Edwards,

2

2005: 1), are afforded privileges by virtue of their higher socio economic status,

unavailable to other social classes. Expectations of birth on the other hand, are

said to derive from social class, shaping women’s choices, expectations and

perspectives (Martin, 1987: 197). Research has confirmed that middle class

women adopt an active approach to birth, while working class women adopt a

more passive approach (Zadoroznyj, 1999). Lazarus (1997) accounts for

distinctly different priorities between working and middle class women, whilst

Nelson’s (1983) research attributes different values and purposes to middle and

working class experiences of birth. The present study is located within the

spectrum of middle class women’s birthing needs, preferences and

opportunities. This study offers a way of understanding the consequences arising

from home birthing women’s child birth choices, in terms of maintaining a

coherent sense of self, through a disruptive, life-changing event.

This paper was drawn from a wider qualitative study that explored the personal

narratives of six women from the greater Cape Town area in addition to five on-

line South African birth stories. The four case studies presented here seek to

reconcile the discrepancy between narrated birth experiences and actual birth

experiences, by analysing ‘interference’ in home birth narratives. Interference as

it is here refers, relates to disruptions or discrepancy in either ‘planned’ or

‘lived’ home birth experiences. Lacking overall coherence in the birth narrative,

interference as a phenomenon produces changes that alter or modify imagined,

as well as actual home birth outcomes. Such interference, unlikely to be

subjectively identified as an ‘intervention’ in the birth process is nonetheless a

disturbing or obstructing occurrence in home birth narratives and as such, is

worthy of analytical interest. The additional focus on choice, and its function

within the marginalised practice of home birth, serves to highlight consideration

of the factors that allow women to relate to birth in deeply meaningful ways, in

spite of interference.

Research into the relationship between care and identity construction has

pinpointed specific aspects of the social environment that generates subjective

experiences of healing and of wholeness (see Edvardsson et al., 2003). The

implications of middle class home birthing choices are thus considered in

relation to, not only home birthing women’s subjectivity, but the wider “political

purposes, bodily effects and material consequences” that accompany this often

overlooked birth practice (Beckett, 2005: 264). Consequently, these choices

draw attention to the atmosphere, attitudes and prevailing conditions which

afford “relational inclusion and co-presence” in the experience of care during

home birth. (Mason, 2004: 167). Home births validate and affirm the psycho-

social nature of relational birthing subjects in so far as being supported, being

seen and being heard generates a sense of containment and continual

relationship for birthing women. Thus suggesting that feeling and being at home

3

- both literally and figuratively - enables social environments of care that

transform local, everyday experiences of birth.

Context (Home birthing in South Africa)

In South Africa, socio-economic factors largely determines not only access to

health care (Mooney, 2012), but impacts on the quality of those services too

(Chadwick et al., 2014). Whilst total health care expenditure amounts to 8.7% of

GDP, (Engelbrecht and Crisp, 2010: 196) a remarkable 60% of that goes directly

towards the private sector (Parkhurst et al., 2005: 132) which only services 16%

of the population (McIntyre, 2010: 148). Such skewed access to resources,

whilst exacerbating existing social inequality, has significantly different

implications for middle and working classes, which briefly need sketching when

it comes to women’s child birth choices.

The delivery of obstetric care, located as it is, within a bifurcated maternal

health system, is highly unequal. Women delivering in private hospitals in South

Africa have been declared the world’s most likely to have a caesarean section

(Burns, 2001 cited in Chadwick, 2007: 11). Within the current maternal health

system 93.5% of women give birth in a medical facility, yet of these, only 6%

do so in private hospitals (Chadwick and Foster, 2013a: 321). As a resource that

services mainly middle to high income groups, the private sector has an

astonishing caesarean section rate of 65% nationally (Naidoo and Moodley,

2009: 257). Therefore, middle class women’s highly medicalised experience of

birth far surpasses the World Health Organisations maximum suggested

caesarean section rate of 10-15% (WHO, 1985).

Blatant misuse of obstetric technologies as a consequence of the privatisation of

healthcare has been acknowledged to over-treat those with medical insurance

and to under-treat or disregard those without (Beckett, 2005: 256). Echoed in

findings with low-risk South African women expecting ‘natural’ deliveries in

private hospitals, Humphrey’s (1998) middle class participants all experienced

intrusive medical interventions during labour and birth. Highly medicalised birth

has long been an undisputed outcome of hospitalisation (Oakley, 1980; Miller,

2005) that in the South African context has even more damaging repercussions

given both the overwhelming tendency towards caesarean section in private

hospitals and the inadequate health practices in public hospitals.

Avoidable health system failures (Chopra, et al., 2009: 369) plague publically

provided health care facilities, contributing to unacceptably high and increasing

maternal mortality (see Blaauw and Penn-Kekana, 2010; Chadwick et al., 2014

). Maternal and child mortality, rated as the fourth burden of disease, features as

4

a prominent health issue generating far more research interest on

underprivileged women’s experiences of childbirth (Jewkes et al., 1998;

Chalmers, 1998; Abrahams et al., 2001; Nzama and Hofmeyr, 2005; Chadwick,

2013; Sengane, 2013; Chadwick et al., 2014). Privileged women’s experiences

of childbirth are less likely to be explored. Experiences of home births are least

likely to be explored, with one key author publishing all known research on

middle class women’s home birthing experiences (see Chadwick, 2007; 2009;

2012; Chadwick and Foster, 2013a; Chadwick and Foster, 2013b). Yet the

detrimental consequences of polarized experiences of hospital based childbirth

strongly suggest the need for alternative, out-of-hospital settings that meet

women’s childbirth needs. This paper, in analysing middle class women’s

experiences of birth, argues that for these women, home birth is one such

alternative, which directly and indirectly supported women’s interests, and the

interests of both their immediate and wider communities.

Independent Midwifery: An alternative, largely unexplored context for childbirth?

Understandably, home birth, accounting for an absolute minority of all births is

under researched. However, the affordability of independent midwifery costs in

middle income terms means that (in addition to those already drawn to

midwifery) those without medical aid are more likely to consider it (Sheldon,

2008: 84). Specific, localised socio-cultural nuances (Viisainen, 2001: 1109)

contribute to problematizing a deeply unequal health care system’s ability to

meet women’s birthing needs adequately. Particularly in light of a highly

medicalised birthing culture and lack of support for midwifery and home birth

(Chadwick, 2007: 14) considerable obstacles prevent middle class women from

seriously considering home births. The profession of independent midwifery

which sustains home birth is dwindling in numbers and constantly under threat

(Chadwick, 2007: 13). Subsumed under The South African Nursing Council

(SANC), with no independent, direct-entry qualification and inadequate training

of nurse-midwives (see Daniels, 2012), has intensified the marginalisation of

home births. Additionally, recent legislation requiring gynaecological back-up

for all VBAC’s (vaginal birth after caesarean section), now makes VBAC’s, at

home, virtually impossible. This drastically reduces middle class women’s

chances for a ‘normal’ delivery following a caesarean (Rothman, 2012: 50),

perpetuating exorbitant caesarean section rates. Because the choices women

make are shaped by social, cultural and political structures (Chadwick and

Foster, 2013: 332), these choices, in turn, shape birth outcomes and the resultant

birth culture.

5

As recourse against skewed delivery of obstetric care, independent midwifery

has largely been ignored in maternal health policies. Yet the possibilities for

social and health reform are extensive (see Kitzinger, 2005). Home births

dismantle the dominant concepts of birth that create fear, disempowerment and

consider high-tech obstetric practices as normative (Cheyney, 2008). Research

into home births and the practice of midwifery that supports it, promotes and

generates an entirely different ‘body of knowledge’ from that produced in

institutions (Rothman and Simonds, 2005; Beckett, 2005). The difference is

greater equity in terms of scarce health resources, lowered dependence on

technology and the ability to subject obstetric knowledge to enquiry and critique

(Beckett, 2005). The model of care practiced in independent midwifery’s

approach to birth is relevant to the greater context of meeting women’s wider

reproductive health needs, with soft benefits contributing towards gender

equality and the realisation of women’s rights (UNFPA, 2011), much needed in

the South African setting. In prioritising continuous care, the midwifery model

advocates for trusting, open relationships that develop through one-on-one

concern, from a dedicated caregiver, for the duration of the childbearing cycle

(Edwards, 2005: 23). As a result, there is greater investment in birth outcomes

by pregnant women and caregivers alike.

Theoretical Framework

MacDonald (2006; 2007) found midwifery itself utilised to challenge normative

constructions of gender. In particular, being offered choices – a central tenant of

midwifery care – validated women’s feelings by employing fluid, contingent

definitions of what can be considered ‘natural’ during birth(MacDonald, 2006:

248-251). ‘Natural’ birth became synonymous with the midwifery model of care

in recognising women and their bodies as intrinsically capable (MacDonald,

2007: 70). The ‘natural-ness’ of birth however, is a vastly contested, and

complex form of empowerment for women (Viisainen, 2001; MacDonald, 2006

and 2007; Mansfield, 2008). Chadwick and Foster (2013a: 317) found that

natural childbirth was seen to ‘regulate’ home birthers behaviour to such an

extent, that ‘natural’ became non-negotiable, acting as a “gendered technology

of power” overseeing middle-class women’s childbirth preferences. Whilst

reproducing essentialist and alternative scripts of birth (Chadwick and Foster,

2013a: 329), discourses of the natural, are nonetheless understood to be one of

few ways of articulating a ‘woman-centred’ language of birth (Chadwick, 2007:

229). Positioning women as capable and sure, in natural birth (MacDonald,

2006: 245), the birthing woman is pivotal, their bodies authoritative and their

experiences are seen as authentic and real.

6

In contrasting home with institutional birth, home birthers positively associated

increased authority over their birthing experience with the following words:

‘‘freedom, control, autonomy, and lack of hospital-imposed restrictions’’

(Boucher et al., 2009: 124). This contrast, Boucher et al. (2009) argue, stands

out as a conflict of interest relating to issues of power and control. Owning the

space, either literally or figuratively allows women control over the birth place

practices that shape understandings of birth (Rothman and Simonds, 2005: 88).

Home births, based on a fundamentally different value system, with contrasting

meanings to medicalised birth, afford women different choices. Several authors

have noted with irony that accompanying the institutional trend towards homely

fixtures and features for delivery has been an increase in caesarean section rates

(Rothman and Simonds, 2005; Cheyney, 2008). Rothman and Simonds (2005:

91-93) thus convincingly argue that the hierarchies of power associated with

place cannot be shifted, even if appearances can. Home births give a birthing

woman “the choice to control her own body and space” and this they conclude is

exactly why medical institutions oppose it and why it’s worth fighting for

(Rothman and Simonds, 2005: 103).

Writing in the genre of the sociology of birth, Rothman (2012: 51) calls

attention to the contentious issue of safety in home births as the difference

between feeling safe and being safe. The literature unanimously concludes that

women who choose to birth at home do so for the freedom, safety and comfort it

offers (Klassen, 2001; Rothman and Simonds, 2005; Edwards, 2005; Boucher et

al., 2009). Safety, as defined by home birth expert, Edwards’ (2005: 96) is the

capacity for deep sharing, patience, respect and admiration, where “trusting

relationships, autonomy and safety become utterly inseparable to this way of

thinking”. Despite this, in both mainstream and academic circles, the safety of

home births is constantly contested. Given the number of publications by the

Cochrane Collaboration and British Medical Journal which testify to the safety

of home birth outcomes (Anderson and Murphy, 1995; Wiegers et al., 1996;

Johnson and Daviss, 2005; Fullerton et al., 2007; de Jonge et al., 2009;

Birthplace collaborative group, 2011; Olsen and Clausen, 2012), what is

understood as ‘safe’, in home births, is reconsidered and re-evaluated according

to fundamentally different principles. The resulting capacity of women in a

home birth to act, look, do and be with whatever feels right, creates and

maintains being safe; being supported; being heard; being understood (Edwards,

2005: 150-155).

Chadwick and Foster (2013a: 332) maintain that such childbirth choices are not

merely products of rational agential decisions, but in pointing to the importance

of social contexts in shaping choices, compels us to ask about the specific

contexts in which home birth ‘care’, which facilitates such choices, is provided.

Correspondingly, the social conditions, present on ward floors, which facilitated

7

a coherent sense of self throughout a disruptive and life transforming event,

were surprisingly similar to home. The insightful work of Edvardsson et al.,

(2003) has direct bearing on the adaptation of a theoretical framework that

privileges the psycho-social nature of relational home birth subjects. These

authors identify four dimensions of care that impact on the construction of

identities. ‘Experiencing calmness’; ‘being seen’; ‘being who you want to be’;

and ‘recognising the self’, were critical elements of a social environment of care

that communicated a welcoming sense of “being at home” in the experience

(2003: 381-385). Their conclusion is that the psycho-social dimension of human

interactions within a setting, account for experiences of care that either aid or

impede the realisation of the self (2003: 390-392).

Cheyney (2008: 265) derives three theoretical categories which, in home births,

translate into practices that sustain and integrate the concepts of knowledge,

power and connectivity to produce a “systems challenging praxis”. The

embodiment of these concepts and adaptation of birth place models, which

foster relatedness, mean that home births not only correct the skewed power

structures of medical systems, but also challenge the basis of medical hegemony

(Cheyney, 2008: 255). Correlating the view that South African birth expert

Rachelle Chadwick (2007: 225) has determined about home birth choices - they

are located within an alternative epistemological position on birth - gleaned

through “knowing-in-relation”. The birthing woman, articulated at the centre of

the experience is poised “between the birthing body, cultural stories of childbirth

and the midwife” (Chadwick, 2007: 227). Through ‘knowing in relation’, birth

comes to be known experientially; knowledge comes through the body, and

what is known, is gleaned through a series of interactions and connections with

significant others, the body and culturally derived sources of meaning

(Chadwick, 2007: 225-226). These findings suggest that in South African as

well as internationally, ‘lived’ experiences of home birth alter perceptions of the

nature of childbirth itself (Rothman and Simonds, 2005; MacDonald, 2006 and

2007; Cheyney, 2008).

Although Chadwick (2007: 227) insists that “knowing in relation” is not a ‘pure’

position home birthers maintain, such an alternative epistemology has direct

bearing on the social aspects of care that impact on the capacity to make

meaningful birth choices. The birthing woman’s experience of care is contingent

upon an environment where “people, selves and values are conceptualised as

relational, connected and embedded” (Mason, 2004: 163). When individuals

become interwoven as relational selves, during home births, the care that

substantiates meaningfulness is felt, received and lived in mutually inclusive

ways (Mason, 2004: 162-164). A relational epistemology of birth, as premised

on ‘experiential’ knowledge, has been identified in narrative constructions of

8

home birth as told using a narrative of ‘lived birth’ to script an empowered,

embodied agency (Chadwick, 2007: 267).

As Chadwick (2007; 2009) makes clear, research which prioritises the

subjective experience of childbirth is seldom articulated. Yet, how women make

sense of and interpret their specific experience is essential for creating the

conditions necessary to meet women’s maternal health needs. An extensive

review of Chadwick’s work indicates that the experience of (home) birth on

women’s subjectivity is often contradictory and unstable. While more is known

about home birth as an alternative way of coming to know birth, less attention

has focussed on the ambiguous nature of birthing subjectivities. Taking as my

starting point, home birthing subjectivities as subjects in flux, the analysis which

is to follow traces the tensions and interruptions in birthing narratives that offer

ways of conceptualising birthing subjectivities as situated, dynamic and

connected. The inter-connectedness of people and place in an environment that

reflects ownership and agency, allows for embedded relationships to sustain the

idea of an uninterrupted self.

Such an approach necessitates broadening the focus of enquiry in home births to

explore the kinds of care women experience in home birth that impact on their

subjectivity. How do women who undertake home births experience safeness,

naturalness and wellness? All of the women in my sample interrogated their

caregivers in some way or another. They recognised that their care givers would

irrevocably impact on their experience, and thus, carefully considered the

implications of place, space and person. Their experiences and the meanings

they attach to them, highlights an aspect of the literature that is under-developed.

Why and how do women who choose home birth negotiate the social

environment of care?

Methodology

This paper will analyse four case studies, according to their themes, sequence,

affect, structure and linguistic choices (Riessman, 2001: 6-8) to understand the

ways social environments of care uphold safety, intimacy, connection and

agency. The analysis maintains that what is said about birth is as important as

how it is said. Narrative methodologies, in allowing the process of interaction

between teller and listener to be intrinsic to the formation of meaning, re-

establish the primacy of intimate inter-personal connections to the production of

knowledge (Riessman, 2001; Mauthner and Doucet, 2003). As such, it reflects

the theoretical stance of home birthers who prioritise close, caring relationships,

and female centred, intuitive knowing (Cheyney, 2008). Insights into the

relational nature of the networks surrounding home birth make this

9

methodological choice critical to understanding how women’s experiences

shape their birth choices and how choices, in turn, shape birth experiences.

As a home birther myself, I wanted my interpretations to be led by the teller, to

ascertain the significance they themselves attach to their experience. Precisely

because of the subjective nature of women’s experience during childbirth,

narratives align the teller with their own best intentions; providing creative

justification and impetus for what they think, say, do and feel, even if in reality,

these are not clear (Riessman, 1990b: 1199). Narrative studies represent reality

by focusing on storied ways of knowing, and communicating through language

as it is derived from social, cultural and historical resources (Riessman, 2005:

1). By interpreting the social world, the narrator links the personal with the

political in ways that are situated, imaginal and fluid; yet these shifting

dynamics are integral to the construction of identities (Riessman, 2001: 20).

Birthing practices are central to women’s narratives, ways of knowing and the

means through which identities can be claimed, undone or re-made (Klassen,

2001: xiii). Narratives are therefore valued, because in crediting subjectivity,

they create texts that allow what is most influential to the teller to become

known, drawing together social, cultural and personal worlds (Mason, 2004:

165). Birth narratives, embedded in the life story of the narrator offer reflections

on changes to self and society that reveal factors, which both motivate and

constrain, choices.

Qualitative research designs need to be flexible, to allow for decision making to

take place as the research is unfolding (Mason, 2002; Ritchie and Lewis, 2003;

Punch, 2005). This flexibility was applied using three sampling and recruitment

strategies. My first gate keeper forwarded my introductory email to a home birth

mailing list. Another gate keeper sent me names of previous clients to contact

via facebook. This led me to my second strategy which was to post on my

facebook page: Know of anyone in Cape Town who has given birth at home

within the last year and had a midwife present? Please could you pass me their

contact details - or mine to them? Thanks! This strategy proved particularly

successful. Through snowballing, it brought forward an important negative case

in which a home birth was transferred to hospital.

The interviews were arranged to take place in participant’s homes, at their

convenience. The interview was structured in an organic way, sensitive to the

dynamics taking place in the homes of participants. More often than not,

children were being attended to as the interview took place, requiring the

prioritising of their needs, rather than my own. I always accepted tea and

engaged in small talk before the interview in an attempt to ‘be on their ground’.

Once settled, I proceeded to ask about the home birth: “As you know I’m

interested in the stories of women who’ve had a home birth with a midwife.

10

Would you please take as much time as you need and tell me in as much detail

as possible the story of your child’s birth?”

The ethical concerns of social science research require that the researcher protect

the identity and integrity of the individuals upon whose contributions this study

is based. The potential for harm in such research is often in the form of

emotional distress resulting from a breach in trust that comes with exposing

others’ intimate stories (Gabb, 2010: 471). Presentation of these findings and the

narrative sequences upon which the analysis is based have thus had to ensure

that key identifying markers were either erased or altered. In particular, related

individuals and the communities of which they are a part should be unable to

identify the actual individuals and situations discussed. The relational dimension

of these stories makes this a challenging but vital aspect of disclosing personal

narratives. Pseudonyms have been used for throughout to disguise the names of

husbands, family members, geographical areas, midwives or doula’s mentioned

by the narrator (except in the case of known birth experts). Ethical clearance was

gained from the Sociology department at the University of Cape Town, and all

standard protocols regarding informed consent, confidentiality and anonymity

were followed.

Methods of Analysis

Formal methodological models of narrative analysis abound, however I found

the work of Catherine Kohler Riessman, provided the most useful application of

various analytical forms. I felt it appropriate to be flexible in my approach, to

gain coherence through a multiplicity of techniques and thorough engagement

with the data. Attentiveness to metaphors, key words, verb tense and other

linguistic choices focused my analytical interest on the structural interpretation

of why something was said in the way it was (Riessman, 1993: 52). Engaging in

an iterative way with the narratives allowed my interpretive understanding to

deepen. By identifying segments of the text and examining how they support

particular interpretations, I was making methodological choices regarding

different approaches. For example, although I trace affect in the narratives of

both Gayle and Joy, Joy’s narrative was represented according to its poetic

structure. This representation privileged Joy’s situated, emotional response

within a small narrative segment. Whereas with Gayle, only after parsing her

complete narrative, in which 6 different stories are told in 3 parts, could affect

come to represent the heart of her narrative when traced throughout.

Methodological choices such as these reflect the different narrative styles chosen

by the participants. A variety of methods were thus used to interpret the

narratives, while different representations of the texts allowed me to analyse

meaning at different levels, ensuring the rigour and reliability of the process.

11

Riessman (1993) suggests that analysis of narratives should begin using the

outline provided by Labov. This approach is suggested because Labov identified

a common set of elements around which narratives are organised, which is

judged to be a useful starting point, given that it prioritises the structure and

organisation of the narrative response (Riessman, 1990b; 1993). The abstract

(AB) tells us what the story is about; the orientation (OR) tells us who, where

and when; the complicating action (CA) tells us how: it is the central plot of

what happened; the resolution (RE) explains why it matters; the coda (CODA)

returns to the present and ends the story (Frost, 2007: 4). However, it is the

evaluation (EV) that is said to be the soul of the narrative (Riessman, 1990b:

1198). Evaluative clauses convey the quality of mind and attitude of the teller.

These are important because they provide a way for the analyst to reflect on the

impression the narrator composes of themselves, by which the listener is

convinced (Riessman, 1990b). Nonetheless, not all stories can be read by

applying Labov’s framework. Labov argued for chronological order, in topic

specific narratives where “what happened” is causally sequenced (Riessman,

1993: 17, 59). Riessman (2001: 6-7) makes us aware that subsequent authors,

including herself have extended the approach for application in multiple forms

of narrative discourse. In this way the strict order of the Labovian framework

can be rearranged, although the set of elements for interpretation remain the

same.

Analysis

Care that affirms and supports trust in oneself: Annie

The job of identifying narrative segments comes through close textual analysis

of the speaker’s organisation of their narrative (Riessman, 1993: 58-60). Such

segments tell the core story that supports particular interpretations of the lived

experience being narrated. Annie’s narrative of the home birth of her third

daughter has many of the structural elements that allow it to be parsed according

to the outline provided by Labov (Riessman, 1990b; 2001). The characters, plot,

setting and time frame are all clearly articulated and referenced in relation to

what happened. Annie’s narrative tells the story of a disagreement with her care

provider that causes her to feel ‘I’d rather do it on my own’. Such a drastic turn

of events was hardly arbitrary, thus, she has a hard job convincing the listener of

her point of view. As the start of her birth narrative proper, this segment

sketches an outline of the right way and the wrong way to give birth according

12

to the narrator’s interpretation. This dichotomy is maintained throughout the

entire narrative for a very distinct purpose.

“I mean it, it was quite scary”

I was actually going to have a gynae, AB

um Bianca and um we ended up having a really big argument

about how she was going to handle the birth.

With Magda’s birth I haemorrhaged quite a bit and um, OR

she wanted to have quite an active management of the afterbirth.

And I wasn’t happy with that at all.

You know, cord clamping and all that kind of thing. CA

I really didn’t want that and,

we had a big fight about it and

she eventually agreed to do what I wanted, but

I just felt she was going into the birth expecting things to go wrong. EV

Yah, you know I read a book called birth and breastfeeding OR

by Michel Odent ….. Um well

that book really talks about the importance of privacy in birth and I think

after I read that book I almost felt like I’d rather do it on my own EV

than have someone I didn’t want there……..

And, yah and then at the last minute…….. CA

Fiona said well why don’t you try Acacia, you might you know, get lucky.

It was really, kind of a luck. EV

I think I was about 36 weeks and I phoned Acacia OR

and she managed to wrangle things, so she could do the birth.…

I mean it, it was quite scary EV

and um anyway her dates kind of just coincided. CA

But I needed to be on time with the birth to have her

so that was a little scary (laughs). EV

But, it did work out.

I took, when I was 40, 40 weeks exactly I took castor oil OR

and that brought labour on.

I mean I actually really needed someone like Acacia EV

because I think um Bianca felt that, considering my history,

she reckoned I shouldn’t have considered a home birth….

Whereas, I think Acacia was very, very open minded RE

and much more trusting.

And I think I needed someone to trust that process. CODA

Annie’s narrative of different approaches to maternity care highlights the

importance of choosing caregivers whose views align with one’s own. In

13

orientating the listener, Annie explains that due to severe haemorrhaging in her

second birth, the suggested approach to managing her risk caused a serious

altercation between herself and Bianca. For Annie, approaching the birth with a

‘medical’ outlook imposes negative expectations on the natural process of birth.

Although this is the story of her third daughter Samantha’s home birth, the

outcomes of her second home birth create significant interference in this

narrative. The problem Annie faces is how to translate her confidence that things

would work out into a story that doesn’t sound careless. Annie’s certainty and

clarity that things are as she sees it is sustained in the narrative through a

habitual rendering of events. In this narrative form, few stories are told and the

general course of things is spoken about, often without dramatization (Riessman,

1990a: 76-78). The listener is not drawn into the story or called to re-live the

moment with the teller, with the content of the experience never being fully

elaborated on. In Annie’s narrative, it is her belief in what is natural that is

actively argued for and central to her interpretation of events.

‘Considering my history, she reckoned I shouldn’t have considered a home

birth’, highlights the fact that Annie is high risk. As a consequence, her decision

to have a home birth, insistence on a ‘hands off’ approach, and dependence on a

caregiver who is possibly unavailable creates a massive tension in the narrative.

This tension is off-set by the strength of her conviction and steadfast belief in

the natural physiology of birth. ‘Someone like Acacia’ who is open to and

completely trusting of home birth is aligned to internationally renowned, leader

in the field of natural birth, Michel Odent. By utilising known natural birth

experts to advocate for Annie’s idea of how to ‘handle the birth’, this narrator

lends credibility and legitimacy to her opinion that Bianca’s approach to the

birth was flawed.

Her credence in the birthing women’s authority and expertise is tantamount to

viewing herself as ‘the specialist’ in birth. Given this perception, as much as

Acacia may come to represent natural birth, having her at the birth is presented

as nothing more than ‘a luck’. She later explains that even though ‘Acacia was

amazing….she just helped the process. You see I did it, she didn’t do it.’ While

this is hardly an exaggeration, it ignores the fact that Acacia had to untwist

multiple times, a tightly wound umbilical cord from Samantha’s neck. Clearly,

we need to be attentive to the impression that Annie is creating for herself.

Michel Odent is a French endocrinologist and midwife well-known for his

vociferous support of natural, uninterrupted childbirth (Sheldon, 2008: 60-61).

Advocating for trust in a women’s body, Odent, having studied the “behavioural

effects of maternal hormones” insists that women have primal, intuitive

knowledge of birth (Odent, 2012: 86-87). For Annie to align her views so

closely to his, by choosing to birth in a manner cognisant of his key teachings,

she constructs a particular self for whom a puritan view of childbirth is deemed

14

morally correct and superior to the medical approach. The strategic presentation

of a birthing self that draws on a repertoire of known social, biological and

scientific evidence supporting natural child birth serves to validate Annie’s

moral character. By evoking such a distinguished writer, she is providing

evidence to support her claims that ‘natural’ child birth is the right way to birth.

Individuals “engage in the creation of reality in their tellings and re-tellings,

constructing their world and themselves through interpretation” (Riessman,

1990a: 13). Many of the key interpretive qualities used by the narrator to

substantiate the meaning she claims for herself and her approach to her home

birth are present in her narration of her second daughter’s birth.

And urgh yah, with Magda’s birth, I was just knocked for a six

and not really able to cope with it……

N: It seems like Magda’s birth is a really important story for you?

Yah so Magda’s birth was, t’was ok,

it was fine I mean I - you know, she was fine,

in the end I was fine but you know,

it wasn’t like I had to use any drugs,

but it was really traumatic……. And um,

whereas shoo with Magda’s birth I couldn’t walk up the stairs for two weeks,

it was, it was really (pause) hectic, I think.

And, you know, I was really badly torn and it was,

yeah there was the haemorrhaging,

it was just, it was very, very traumatic.

I mean the haemorrhaging was quite bad and it was quite serious

but it was handled really well and I’m fine

– because women can die from it,

um but it was much more medical kind of thing.

The way she chooses to tell the story of haemorrhaging at Magda’s births shows

a divided subjectivity. When Annie says ‘it was handled really well because

women can die from it’ she clearly understands that those very same medical

procedures which disempowered her, also saved her life. Such a connection

however, could not be made by the narrator, because she is determinedly

‘natural’ in her outlook. Due to the birth having become a ‘medical' event, it is

perceived by Annie to be the wrong type of birth. In the segment above, what

seems to take precedent in her re-telling of being ‘unable to walk’ and ‘really

badly torn’ is the fact that she didn’t need any medication. Not having to resort

to drugs, means having retained the principles of natural birth, which in the face

of its medicalization, seems to have been the primary point the teller wishes to

make. Annie’s struggle for the right type of birth, with the right influences,

15

augments her drastic decision to seek alternative care in the final stage of her

pregnancy.

Annie’s narrative is not purely sequential, as habitual rendering of stories often

are and this attunes us to the role of Magda’s birth in her story. It is a disturbing

interference in the narration of Samantha’s birth, but plays a vital role in

recapitulating Annie’s choices for a home birth, the third time. Her insistence on

undisturbed mother – child bonding after delivery; delayed cord clamping; the

separation of men from the labour and birth process; her fervent belief in birth as

a natural process; and in her own capacity to birth, all support her view that

‘birth is not a medical process’. This position is sustained through referral to

known birth experts; both Acacia and Michel Odent are used in support of her

choices. In this respect, her argument with Bianca is not only a matter of

opinion, it’s about who controls the power to determine what happens in birth.

Although Annie makes it clear through numerous repetitions that her second

birth experience was hectic and traumatic, what is specifically experienced as

disempowering is the fact that it became a medical event. Through the

medicalization of her birth, she lost control of her own experience. Specifically

stating later on that ‘I think part of the problem with Magda’s birth was that

there were too many people, it was too medical, even though it was at home it

was um, it wasn’t really my process, it was taken over.’ Suggests that place of

birth is not necessarily enough to circumvent the hierarchies of power which

disempower women’s birthing selves. The conditions which support women’s

empowered birthing selves are based on choices made the entire way through

pregnancy and labour. Carefully attending to the optimal conditions that create

trust, safety, relationship, intimacy and agency, engenders a social environment

where the highest outcomes for birth can be achieved.

In her third birth, Annie is left with an undisputed sense of her own

achievement. The psychological impact of a positive birth experience, seen as

both a personal and physiological victory, is as meaningful as it is healing.

While clearly still suffering from the trauma of her second birth, her third birth

is unquestioningly narrated as ‘lovely’, ‘easy and nice’, ‘a wonderful

experience’. Thus, her narrative upholds generalisations that take for granted a

particular view of the world. For Annie, as a vegan and spiritualist, her

conviction that the natural way is the best way must be represented by outward

actions that match her inner commitment. In upholding her version of the truth,

this narrative creates an ‘emotional and spiritual’ context of birth that

nonetheless is embedded with social and political purpose. Annie creates a

narrative in which she claims authorship over her birth rights by privileging

subjectivity. In subverting the status quo and reasserting the right and authority

of women to make choices about their own bodies in childbirth, this narrative

16

tackles topical social and political issues. Through this subjective account of a

home birth, the controversy over who controls the power in birth is shown to be

intimately tied to the possibilities for healing birthing selves and empowering

women.

Care that acknowledges who you are: Hannah

Hannah’s narrative is lengthy and not framed in any clearly discernable manner.

Although temporally sequenced, this long re-telling of the attempted home birth

of her daughter was based on a complex arrangement of linked ideas that was

dense, wordy and difficult to make sense of. Openings into vivid recollections

and deep feelings would render long stories. Sentences would be repeated but as

they were, more of the story attached to them would be unravelled, connecting

seemingly disparate aspects of an inter-related pattern into a deeply intimate,

multi-faceted narrative. Hannah convinces her listeners of her interpretation of

events due to the way in which she structures her story which supports her own

particular lived experience (Edvardsson et al., 2003: 379). Interpretation occurs

through representation, and finding the most suitable technique to begin

unpacking key elements was a vital analytical prerequisite. My structural

analysis was thus drawn from the work of James Gee as explained by Riessman

(1993: 44-52). This form of representation is not always useful because it can

cut away too many of the narrative clues which signify meaning (Riessman,

1993). In this case, a more simplistic representation of an already complex

narrative structure was a useful way to begin.

Detailed interpretation highlighted a narrative arranged episodically with a total

of 23 scenes, each ending in a coda or summary. Parsed sentences were grouped

into stanza’s on a single topic and labelled according to the theme or prominent

idea (using the narrators own words). At the end of a group of stanza’s the

narrator would naturally end that set of ideas and present the listener with an

outcome which would then return to the main plot of the narrative (Riessman,

2005: 3). Naturally organised into scenes which included between 3 and 7

stanzas plus a coda, with 3 - 4 scenes making up a part, coherently structured

into 6 themes: labouring at home, evaluations and expectations, being in

hospital, ‘I remember snippets’, post-traumatic stress and owning the full

experience. Only by parsing the narrative in its entirety could the inherent logic

and connection to the life story of the participant become clear.

Hannah’s narrative tells of a planned home birth that ended up as a caesarean

birth in hospital. In a particularly salient comparison of the experience of home

birth versus hospital birth, Part 3 (‘being in hospital’) uses pain as a descriptive

17

word for the very first time, to describe the physiological sensations of labour1.

We know that her contractions have been ‘strong enough and regular enough’ at

home. Yet when Hannah reaches the hospital, a sudden awakening of the

experience of pain dramatically focuses attention on the discomfort that

constraining physical and structural factors provoked in her.

Stanza 41: (Not pleasant)

290. So there, there I was,

291. I was out of it,

292. I was tired,

293. I was uncomfortable,

294. I was in pain

295. it was, it was really not pleasant.

The first three scenes of Part 3, ‘being in hospital’, (scenes 7, 8 and 9) showcase

the documented potential of “ward atmosphere (to) create alienation from self,

others and the surrounding world” (Edvardsson et al., 2003: 385). The

imposition of standard, non-negotiable protocols that such an institutional

context requires, curtails the experience of freedom she had at home. It restricts

her ability to respond to the physical experience of labour ‘so there I was really

battling figuring out how to cope with it’. Restrained as she is within her

birthing body, the cumulative effect of the ‘hard baths’, ‘the CTG’, the ‘hospital

regulations’ requiring her to be ‘strapped down’ become a debilitating force,

infringing on her ability to find respite. A strong sense of disempowerment

permeates this narrative segment, as the role Hannah plays in her own labour

becomes a subservient one. Seriously lacking the choices to manage her labour,

the heightening sensation of pain creates an aggravation which reduces her

capacity to impact positively on her own experience. Showing distinct signs of

fatigue and anguish, it quickly becomes clear that Hannah faces only ‘one

choice….. caesarean’.

Scene 8: How long do we still have to go? Stanza 43 (Worst for me)

308. Oh and the worst for me, that’s a funny one.

309. One of the worst things for me was the CTG.

310. It was, it was horrible! [my emphasis, demonstrating tone]

1 It is worth noting that none of the narrators of home birth in this sample utilise the word

‘pain’ in describing their physiological experience of labour and birth.

18

311. Um cause you limited. You have to lie on a bed, be in a certain position,

312. you have this thing strapped on

313. and you’re having contractions.

314. And it’s so painful.

Stanza 44 (She hated it)

315. And she hated it,

Stanza 45 (I hated it)

320. and I hated it, it was like, ooohhh

321. and my poor midwife was just like, we have to do this and I,

322. I kept on complaining “how long do I still have to have this thing on me?”

(laughs)

323. But it was so painful!

Stanza 46 (Hospital regulations)

324. That, that aggravated, it really aggravated the whole situation for me

325. being stuck there with that thing on me and,

326. and I mean at home she kept on checking with the doppler

327. and I’m like, you checked me with the doppler, why don’t you

328. - hospital regulations - you know you have to do it.

330. It’s so stupid I think you have to do it for 20 minutes, its, its long.

Summary

334. and that was really horrible, I hated that.

CODA (Counting the minutes)

337. There I was counting the minutes, I was like –

338. how long do we still have to go,

339. how long do we still have to go?

Earlier, in scene 6 of part 2, Hannah made it clear that she abdicates herself of

responsibility for the birth outcomes. Hannah prioritised wanting to be a first

time mother, without her professional judgement clouding her experience. ‘I

didn’t really wanna make decisions while giving birth. So what I did was I made

sure that in advance I have a midwife / gynae team that I can trust, that I feel

comfortable with’. Having constructed her caregivers as the experts, positioned

them as responsible for the well-being of herself and her baby, she allows them

19

to make a choice that is not in line with what she believes, one which she would

not normally choose for herself. Through detailing the open, trusting and

reassuring relationships she has with her caregivers, the caesarean is affirmed as

necessary; as a life-saving measure. Stanzas 53-55 of scene 10 (below) shows

the narrator coming to terms with the outcome of her labour and attempting to

make sense of it. In three consecutive stanzas there are three summaries before

the coda, ‘decision made’, which concludes the scene and part 3 of her narrative.

The significance of this change in structure relates to the state of mind of the

narrator who, still in the process of reflecting on and understanding her feelings,

needs to continually summarise the facts to get to grips with them. In this

scenario, it becomes evident that it was the duty of her caregivers to impose

their will upon hers, and hers to concede to their decision. Through the

structuring of this scene, the listener is convinced of the way Hannah, as a

natural medicine advocate, comes to terms with her caesarean.

Scene 10: Thank God for Caesareans

Stanza 53 (In good hands)

380. But with her, I was like, “I’m in good hands, I’m fine.”

381. It was nice that feeling

384. of ok, it’s not my choice,

385. I can’t believe I’m having a caesarean,

386. I’m so, fanatically natural-medicine minded

387. but thank god for caesarean’s. (laughs)

Summary

388. Otherwise we both would’ve been dead by now most probably,

389. so I was very thankful for her.

Stanza 54 (Don’t feel let down)

390. And what was really nice was she came in and she sat next to me

391. and she said, “do you feel we’re pushing you into this”?

392. And I said “no, I don’t feel like you’re pushing me into anything.

393. I realise it’s the right thing to do.”

394. And what was also awesome was she said,

395. “don’t feel like your body let you down.”

20

Summary

396. Cause that’s what you feel, you feel like an idiot.

397. You feel like I was made to give birth you know

Stanza 55 (Being a woman)

398. I’m a woman and

399. I can’t even do that.

400. You know it’s a silly thing but you think,

401. I’m supposed to be able to do this.

402. It’s the most natural thing

403. and I can’t even do this right.

Summary

404. And if it wasn’t for an operation I would’ve been dead.

405. You know it’s weird

CODA (Decision made)

406. but she was really, really especially nice

407. and from then on I don’t remember much.

408. I think it was, decision made. Okay.

A second, interrelated issue that the interaction with her gynaecologist

highlighted is the idea that women are ‘made to give birth’. Hannah, who is fit

and strong and healthy, could not ‘walk for the last month of pregnancy and then

having a not so wonderful birth’, her perception of who she is and what she is

capable of was altered. The concept herein, that because women’s bodies are

physiologically constructed to give birth, meaning that all women giving birth

should know how to, is significant. It makes clear the subjective cost involved in

striving for a ‘natural’ birth. Without a sense of having birthed her baby herself

(naturally), the effect of a caesarean on Hannah’s subjectivity is deeply

wounding when ‘to give birth’ is conceived as something supposedly

fundamental to her identity as a woman. It creates the impetus, not only to

justify the caesarean, but find peace in the outcome of her body’s birthing

process, which this gynaecologist acknowledges.

The nature of the care she receives from her support team, which recognises not

only her medical risk, but the risk to her person through acquiescing to a

caesarean shows up “the crucial significance of the social environment of care”

21

(Edvardsson et al., 2003: 392). Scene 10 makes it clear that a social environment

of care can circumvent institutional disempowerment and constellate a reality in

which an integrated sense of self can be sustained. The personalised nature of

the care she receives during a disappointing and traumatic adjustment to her

projected reality brings to the fore the human qualities of relating and respect

that engender a sense of trust and safety, in spite of the outer circumstances.

Through a long development of stanzas across consecutive scenes, Hannah is

able to narrate the two worst aspects of her birth experience. Beginning with the

frustrations resulting from the physical, post-operative wound, to having missed

out on the deep, intimate, parent-child bonding that takes place during the first

few hours post birth. In part 6, owning the full experience means exactly that;

witnessing her pain and anguish, whilst simultaneously striving to claim what is

personally meaningful. Hannah is aware that if she lets what went wrong in her

birth affect her completely then, ‘it doesn’t feel very natural to me’. And the

laughter that accompanies this statement both times emphasises that this is no

light matter.

She has spoken of herself as a ‘fanatically natural-medicine minded’ person.

Natural medicine is not just what she does, it’s what she is. The energy she gets

from clean living, from being physically active, from knowing she can,

disintegrates if she focuses too much on the details of the birth and not the

bigger picture. Narrating both the depth of her sadness and disappointment with

a deep gratitude for what she does have, indicates that although the emotional

scars linger, she has resolved them for herself. In scene 23, she repeats 3 times

that she is ‘very thankful’ and in so doing concludes her narrative holding both

the hurt and the healing in conscious alignment. After all, her caesarean ‘saved’

her child’s life, but her experience of birthing at home, gave her something

precious too.

CODA (This is it)

773. So I’m consciously going back to that picture that I had

774. of lying in that birth pool and looking at the ocean thinking wow

775. this is awesome, this is beautiful.

776. That is what I want to keep.

22

Care through being in community with self and others: Gayle

To tell her story, Gayle does several things simultaneously. In her opening line,

she sets up a mega-frame which, similarly to a rationale, justifies why this story

is worth telling and makes clear her prerequisites for choosing a place of birth.

‘What was important for me was also to find a very safe place to have birth. And

I wasn’t sure where it was going to be’. Within this mega frame, Gayle tells 10

stories (titled using the authors own words): focussing on myself; private

hospital; public hospital; Ruan is born; my mother’s house; my father’s panic;

‘the families just way too intense’; the birth itself; the signs; the thread

throughout. These stories make sense of the subjective meanings this narrator

attaches to a place of safety, and its purpose within her particular life phase.

Gayle’s search for safety is conducted both internally and externally, as an

exploration of the ‘emotional resonance’ of safety. What makes Gayle safe is

being in connection with that which holds true. The mega-frame naturally binds

the narrative together, offering both a beginning and an ending to the birth

narrative.

As the opening frame suggests, home birth was not the primary birth option for

this narrator. Gayle’s first three stories critically shape her decision to birth at

home. All three mini-stories are told in a manner that allows them to be analysed

according to a Labovian framework. They are “brief, topically–centred and

temporally ordered stories” (Riessman, 2005: 3). The first, ‘focussing on

myself’ discusses her collapse at work that serves to warn her of the possibility

of pre-mature labour. When Gayle’s weakness surfaces it affects the foetus,

making Gayle realise the need to prioritise her safety, in order to protect her

offspring. Her mother’s home becomes her place of refuge and of shelter.

Immediately inside of her organising framework, the story of her need to

‘internalise’, allows Gayle to articulate a need to stop and retreat to a place

where she was able to be fragile and vulnerable. Seen in terms of the broader

narrative in which birth catalysed a disruption in Gayle’s sense of self, this story

can be interpreted as the point at which Gayle begins ‘letting go’ of the idea of

herself as strong, as a necessary part of her own transformation.

The second story is an experience of being in a private hospital where she feels

isolated and ‘alone’. Her relationship to the cold, ‘sterile place’ bringing forth

feelings of alienation and disconnect, that does not engender a sense of safety. In

contrast, her experience of the public hospital in the third story, which she

expects will be horrible, is not. Here she feels warmth, and a welcoming that

encourages a sense of ‘ease’. The feeling of being in community stands out as

cementing her sense of safety in this space. These two stories side by side

23

suggest that Gayle’s subjective experience of safety was turned upside down on

these two occasions. The high-tech, high-end hospital, assumed to be safest, was

not. While, on the other hand, the hospital she ‘was very, um nervous about

going’ to, had the strongest “emotional resonance” of safety, for her personally

(Rothman, 2012: 51). Really being safe, as narrated by Gayle comes from an

environment of care where the qualities of relating and of interaction, bring forth

lasting relationships. Such a relational space, where birth has meaning on social,

cultural and personal levels, was her childhood home.

Being fully attentive to the narrator’s subjective meanings insists that we

recognise the central tension in the narrative according to the teller. Gayle’s

narrative of transformation into Ruan’s mother is told in 6 parts: the collapse;

before the birth; the birth; affect; the birth re-visited; the archetype of

transformation. What stands out, if we privilege Gayle’s feelings and emotions,

by tracing affect as it recurs throughout the narrative is the disruption in Gayle’s

identity due to the birth of her son. It is a massive reduction of the text but is

valuable because it describes the impetus behind Gayle’s individuation; the

interruption to her sense of self, catalysed by the birth of her son. Gayle points

to her physical and psychological break down in lines 26-31. Her weakness is

not only unusual and irregular; it also marks a turning point. For at least a month

before the birth up until a month afterwards, she felt physically and emotionally

constrained. Gayle’s chosen place of birth creates a tension that challenges her

to move beyond her constricted identity as a good daughter, into a good mother.

Affect in the Narrative

26. I was most of the time also just lying in bed

27. after being (really) a very active person.

28. Um and it really helped me to (pause)

29. prepare myself for Ruan coming.

30. I mean I felt very weak (p)

31. and um, it took time, um (p).

73. And, I think a lot of this process was (in breath) about (p)

74. letting go. Just allowing things to happen

75. as – whatever way they come….

77. but it was a very good process (p)

78. of letting go.

172. yah a lot of its been also feeling - not only are you caring for the little one

173. but having to care so much for your parents

174. and all their anxieties which they check down on you.

184. It was very wobbly, at least also for about a month afterwards,

185. it was very very (pause) yah, um took a long time to (p)

24

186. recover that I was strong enough to also just not lie in bed.

187. It was very odd for me because I’m quite a healthy person

188. and I’m (pause) quite strong physically

189. but I think it was valuable to (p)

190. yah, to know your, your ritual of becoming a mother (p)

191. of becoming something else.

192. Um, taking time to (pause) think and be and breathe.

193. Um and not be busy, yeah so (p).

194. Yeah, it was very - Im very, very thankful

195. that I had a good birth.

196. because I feel everything around me was so, is so unstable

197. (pause) um and vulnerable (p).

198. And my birth really gave me the foundation

199. to know that I could pull through.

200. And I mean Ruan is just so, so good,

201. he’s such a kind baby you know –

202. it’s like he’s taking care of us.

203. So (pause) I’m very, very grateful that I had a home birth as well.

220. Um I always felt that um, I’m maybe not so in touch

221. with the animal in me (p)

222. you know um (pause) and also quite shy (p).

223. Also not very sexual, you know all those kind of things,

224. it’s all so new to me. So (p)

225. it’s quite amazing that it all worked well - you know.

229. And then in the end (p)

230. he actually, I caught him myself!

236. and that was really lovely.

243. So that was lucky, and it was interesting,

250. and just, yeah it was very sweet.

275. and it was all something that means something to me already before.

283. But it’s nice that it’s not particular only to that moment that it’s-

284. I feel like this thread throughout,

285. you know the course of my life, that’s nice.

286. Yah (giggle), very, very lucky (pause).

293. I’m also pleased I’m older

294. cause it’s, you lose self-confidence

295. but you also know that you capable of things.

In Gayle’s narrative, her mother, her father and her sister at different parts in the

story are described as ‘freaking out’ (at her). Her sister when she found out she

was pregnant, her father during the course of the birth and her mother

immediately afterwards. In line 196 she locates herself within her family

dynamic, which as a result of her parents separation, is ‘unstable, um and

25

vulnerable’. Her role as the good or ‘easiest daughter’ is threatened by her

parents separation, which is spoken of twice in the narrative, indicating that it is

not a trivial detail for her. Being the good daughter meant looking after

everyone, shouldering their burdens. We see in this narrative, what begins to

take shape, is the realisation that the role of good mother requires that Gayle

begins drawing boundaries around her family’s psychological issues. As a

mother, her resources for everyone else’s ‘anxieties’, diminishes when she

attends to the wellbeing of her son. Thus, the safety Gayle strives for shapes not

only her subjective experience of the birth, but ultimately the environment she

aims to provide for her son. Her transformation into a mother requires her to

trust herself, and her experience of Ruan’s birth provides the basis for her to do

so.

Symbolically uniting both the purpose and meaning of her life, to her son’s,

Gayle’s narrative suggests that the potential for a different ending lies in new

beginnings. ‘Something that means something to me already before…… (that’s)

not particular only to that moment that it’s…..this thread throughout’. Time,

narrative and memory are interlaced in narratives whose structure offers an

account of truth that draws shifting connections between past, present and future

(Riessman, 2001: 20). Throughout her narrative, Gayle emphasises the

connections between her life story, Ruan’s conception, the pregnancy and his

birth. Through the interpretive work of telling stories, new mothers claim

linkages between that which they were and that which they are becoming, re-

fashioning an integrated self to account for both the loss and the gain. Frost

(2007: 5) says that instances of incoherence in events, resulting from disruptions

to an individual’s identity are useful for making sense of changes to the self and

its relationships. Birth as a particularly powerful moment in time, brings to light

the way social identities are made and remade, over time, and in an instant.

Care that connects to what’s most meaningful: Joy

Close textual analysis of the organisation of Joy’s narrative allows me to utilise

a narrative segment to tell the core story (Riessman, 1993: 58-60). Although

there is a distinct plot line, representation of this narrative’s coherence seemed

better suited to stanzas, as its poetic structure lends itself to a discussion of Joy’s

emotional response. I therefore prioritised ‘affect’ in the narrative, whilst being

lenient in my methodological application. The technique I found most useful for

representing this narrative segment is based on the adaptation of Gee given by

Riessman (1993). In relation to the transcription, it is an “ideal realisation” of

the text, whereby pauses and interactions and false starts are excluded

(Riessman, 1993: 44). Insights from Labov’s method have been retained,

particularly in regards to the evaluation of the narrative and the resolution which

26

determined the end of the segment (Riessman, 2005: 3). Looking through Joy’s

narrative and paying specific attention to the patterning of her speech

highlighted the tellers own emphasis. Lexical markers guided me as to the

conventions the teller was using to mark her discourse. Very often a sentence

beginning with ‘so’ was the tellers summary, whilst parsing within stanza’s

accorded to her use of ‘and’. These clues suggested how meaning was sustained

by Joy throughout the narrative and in inter-linking different narrative segments.

Intricate investigation of Joy’s narrative shows her framing the story well, by

orientating the listener to the time, date and place of her planned home birth.

Included in that frame are the factors that militate against being adequately

prepared and in the right frame of mind for the commencement of labour.

According to Joy’s calculations, she gives birth 11 days sooner than she expects.

Evaluating her expected reality with her actual reality helps Joy re-frame her

story towards the end of this segment, to re-align her determination for a home

birth with her lived experience, more fully.

“How it happened”

Frame

Um, so, how it happened,

it was all here, in my home.

Um it was midwinter, so it was like the 14th of July.

And um, my daughter

I thought first baby always comes a week late

and I’m quite the sort of last minute kind of person,

so I was still sort of preparing everything and getting everything ready,

you know the week before she was born.

And then she came four days early!

Stanza 1: Central tension

So on the day when I started going into labour, um,

we had a delivery of furniture

that I inherited from my grandmother

that arrived by truck,

that came

that day.

27

Stanza 2: Labour

So, in the middle of the night

at around 3 o’clock I um

started having these sort of cramps,

which obviously if you’re giving birth the first time,

you don’t know that they’re contractions.

Summary

So I had these experiences

and I thought, oh well

and nothings really bad

and I could still keep sleeping,

so I thought it was fine.

Stanza 3: Central Tension

And then I woke up

at around 7 or 8 o’clock in the morning

the movers called me

and said “we’re here, there’s this big truck and we’ve got all this furniture”

and that’s also when I started experiencing more of the contractions

and realised they really WERE contractions.

Summary

So we had this truck and these people wanting to deliver stuff.

Stanza 4: Trying to fit it all in

And so, my husband had to go to work

and so, I said well that’s fine, go.

And at first these guys arrived

and brought in all this furniture, which in our house

there’s not really a lot of space.

Summary

So we had to try and fit it in our ceiling.

So I was having, by then I was having sort of contractions.

28

Stanza 5: Affect

And people were coming in

and I’d say “excuse me, I just need to focus a bit

and have a little contraction.”

So it was quite an intense start,

not what I imagined.

Stanza 6: Dream sequence

I really imagined having um having a birth where the day would start

and I would bake something

and I’d have my sister who was going to be my doula with me from the start

and we’d be just going through it.

I’d be reading and we’d be practicing sort of meditation

Re-Frame

but um, it didn’t start like that.

She came four days early so first of all I was a bit unprepared,

emotionally, or I think more mentally

and like “urgh, she’s coming”

and I haven’t like bought all the things I need to buy you know,

all these concerns.

Stanza 7: Central tension, expanded

But we had the movers come

and then our domestic worker came

and she started cleaning the house, so there was

she was in my space vacuuming

and that was also quite disconcerting,

Stanza 8: Affect

so I just remember thinking, this is not how I imagined it!

I was like, “NO!”

Stanza 9: (Her concerns)

And my sister couldn’t come until the afternoon

So I…….I’d be sitting in the bedroom

trying to just sort of focus on the pain

29

and I’d call my midwife and ask her, ok this is how far they are apart

and she says, its fine, just keep going

Summary

So I was managing it ok

and I wasn’t really worried,

the sort of contractions weren’t too painful,

I wasn’t getting stressed or worried it was just,

Stanza 10: Resolve

Um, but I eventually told um our domestic worker to go home,

because I sort of felt like I needed the space back

and my sister arrived

and that was great!

Having her, having some more sort of feminine energy

or someone that I could trust

and who was there with me.

Stanza 1 is a description of the central tension: the simultaneous recognition of

labour coupled with the arrival of the movers. Accentuating the delivery of

furniture with her child’s birth-day, this home birth narrative immediately

captivates the listener’s attention. Stanza 2 goes back in time, to the initial

sensations felt earlier that morning which she had dismissed. The disjuncture

created by the uncertainty that marks the beginning of labour with the dismay of

what was happening on this day creates a sort of comedy of errors.

Dramatization builds tension in stanza 3, which not only returns to the

underlying tension, but through the use of present time, brings the plot twist into

real time (Riessman, 1990a). Speaking as the movers, “we’re here” is effective

in heightening the tension, while the rhythm of the story creates intrigue. Re-

living and telling the events, in present tense, with a summary of events, in past

tense, makes for a compelling story. A sense of anticipation and suspense is

woven into the narrative through repetition and the use of various vantage points

on the action. The consequences of the dawning realisation on the part of the

narrator as to what exactly is going on in her body are thus accentuated.

Stanza 4 is symbolic of the way in which the movers’ intrusion into her birth-

space constrained her freedom to respond to her labour: ‘there’s not really a lot

of space’. The effect imposes a disorder and a cluttering of her physical and

psychological space which is quite ‘intense’. Her capacity to relate to her birth

in a meaningful way is compromised. In stanza 5, in light of the restraint

imposed upon her and the uncanny circumstances of her labour, she is reduced

30

to apologising to the work men. In many ways excusing herself (and her body)

is a reaction that relates to the idea of a rogue body in labour: it is un-

controllable, unpredictable, shocking and even rude. Without a way to

comprehend the surprising start to her home birth, Joy reverts to her cultural

conditioning in apologising for the inconvenience of her labour’s disruption to

the normal course of events.

In stanza 6, Joy inserts a “hypothetical narrative” where she presents to the

listener an imagined reality in which she is supported by her sister, has complete

creative freedom and a sense of ease (Riessman, 1990a: 77). What stands out in

this idealised example is the exclusive attention paid to the birthing process by

the labouring woman and her partner. Inserting the dream narrative into the

middle of this segment, alerts the listener to the strived-for reality, that stands in

stark contrast in the lived reality presently unfolding in Joy’s home birth. What

Joy wanted to have happen, didn’t and this was clearly frustrating. She did not

have the time to mentally prepare herself in the way she hoped because of the

‘kind of person’ she is, her husband had to go to work, her sister ‘couldn’t come

until the afternoon’ and this leaves her feeling uneasy, unsettled, with ‘all these

concerns’; quite the opposite of the meditative state she’d hoped for. Evaluating

her hoped for experience against her actual experience helps her re-frame the

story because ‘it didn’t start like that.’

Stanza 7 expands the central tension with the additional interruption of her

domestic helper, and the intrusion into her sonic space of the vacuum cleaner.

When she thus repeats in stanza 8 the emotional affect on her subjective state,

‘that this is not how I imagined it’, the immediacy of her exacerbated ‘No’

reflects the inner turmoil of being constrained within her own home. Her

environment has been physically, psychologically, conceptually, and sonically

absorbed into the mundane. Her retreat into her bedroom to lessen the

detrimental effect of these interruptions is too far removed from an environment

of care, to be comforting. The need to shut off from external intrusions is a

situated response that coincidentally highlights the absence of the type of care

necessary to sustain an empowered birthing self. In stanza 9 there is nothing

essentially wrong, but there is nothing right either. The fact that Joy is now

alone, locked out of interaction with that which brings meaning, energy and life,

explains why the summary is flat, lacking in emotion.

The resolve in stanza 10 brings with it palpable relief. Not only is Joy able to

assert authority over the space, but she is able to claim her own experience. In

an attempt to have ownership over the physiological, emotional, mental and

psychological space of birth, women choose to birth their babies at home where

the possibility of this type of ownership is more feasible. Why does it matter? It

matters because birth is something that can be enjoyed, can be cherished, and in

31

the words of Joy, can be ‘great!’ The narrative segment following this one is

peppered with references to things being great. Her sister’s support is ‘really

great’, her husband coming home and lighting the fire is ‘great’, Kirsten the

assistant midwife was ’really great’, and being in the birth pool also ‘felt great’.

In this segment in particular, the fact that there is relationship when her sister

arrives, ‘someone that I could trust, that was there with me’, makes all the

difference. It is not the negation of interference in a home birth that is affirming.

Rather, it is the continuous connection that witnesses, acknowledges and

responds appropriately to the birthing process which makes Joy feel as if she has

finally, come home.

Findings

Through long descriptive tales, these narratives speak of the ways in which birth

as an act and strived for reality transforms perceptions of the self. Birth at home

gave these participants an opportunity to circumvent traditional hierarchies of

power. However, in so doing it creates situations where women must confront

their individual reality and address pre-held assumptions. Through interrogation

of caregivers; specifically chosen birth attendants; careful consideration of

place; conscious crafting of meaningful birth spaces; attentiveness to emotional,

psychological and spiritual aspects of their physical undertaking, these home

birthers refused to take for granted the nature of their own relational

involvement in birth. The midwife as the main care provider for women in home

births mediates between the physical, psychological and social aspects of birth.

But while this role is no doubt central, it occurs in relation to the social

environment that the birth (or birthing mother) occupies. Care in a home birth

surrounds the birthing mother, allowing her to impact on her environment and

her environment to impact on her.

Doing, being and acting at home during birth, in a characteristically meaningful

environment, allows women to know what they know, in a relational matrix that

positions the birthing woman as essential and central. Mutuality however, is also

a key aspect of such care that creates the necessary conditions for birth to

become meaningful on social and cultural and personal levels. The resultant

enablement or constrainment of birth choices reflects the commitment to

women’s and societies health. Mutually acknowledging and including others

leads to healthcare practices that negotiate caring for both the providers and

receivers of that care, symbiotically. Edvardsson et al. (2003: 390) draw on

research which identifies the “psychosocial climate of a setting”. It is this

climate in a home birth that lies at the heart of the creative capacity of home

birth mothers to circumvent interference and re-inscribe uninterruption into their

birthing narratives. Where the psycho-social aspects of birth figure as

32

importantly as the physical, women are seen and responded to in ways that

allows for integration of the self to reconcile divergent subjectivities.

The kinds of care and support women receive during home birth determine their

capacity to relate to birth in deeply meaningful terms. Annie receives care that

allows her to claim authorship over her own experience. Hannah receives care

that allows her to maintain a memory of giving birth in an atmosphere of calm

presence. Gayle receives care that validates and affirms her connection to a

sense of space and of continuous meaning. Finally, Joy receives care that is

actualised in relation to significant others who, in seeing her, being with her and

witnessing the birth, transform her experience. Through bodily and intuitive

knowledge of how to give birth, women are instinctively drawn to ways of being

with birth that affirm their feelings and give voice to their emotions. Social

environments of care, experienced in home births, generate psycho-social

containment for birth that upholds continuous relationship and supportive

engagement in the process of birth, to refute interruption. By reducing anxiety

and apprehension, generating feelings of safety and security, the correct balance

of maternal hormones stimulates an altered state of consciousness (Odent, 2012:

36) that transforms ordinary experience into extraordinary experience.

The interrupting story of Annie’s second birth exposes a lingering scar of self-

doubt into the narrative of her third daughter’s birth. Her persistent belief in the

right, most natural way to give birth serves a vital and necessary role in helping

Annie claim back an empowered birthing self. Annie’s decision to trust her

instincts, seen as a dismantling of the medical hierarchy surrounding not only

births, but home births as well, validates her sense of self. Standing behind her

convictions, Annie re-establishes a hierarchy of the natural; drawing upon well-

known principles that argue for the primal and instinctual capacity of women to

give birth. Championing carefully chosen birth heroes whose ideals reflect hers,

Annie re-claims an embodied wisdom. Making choices to induce her own

labour, to ensure only those essential to birth are present and insistence upon

delayed cord clamping, she firmly anchors herself in the role of birth expert. By

establishing an active role in controlling the outcomes of her birth, Annie’s

narrative shows how affecting greater trust in her body, herself and her belief

system, allows her to claim her own knowledge, claim her own self.

In providing a rich, detailed account of being listened to, seen as person and

treated as capable, Hannah’s narrative highlights the central importance of a

‘social environment of care’ for retaining a coherent sense of self, throughout

the birth experience. As a medical practitioner, Hannah knew how to be

discerning in her choice of health care professionals and experienced

continuous, uninterrupted care even though care providers changed. Able to

sustain being an active participant in issues relating to her subjective experience,

33

acknowledgement and agency afford her a sense of containment. “Feeling

confirmed, seen as a person, embraced in hospitality and having the chance to

talk openly and freely about emotions and worries are essential for well-being

and recovery of patients” (Edvardsson et al., 2003: 390). Hannah’s narrative is

littered with references to care providers who validate her feelings by taking into

account the personal nature of both her need and her distress.

Gayle’s search for safety is internalised and we see her identifying a place of

safety as residing inside herself as well as outside. This dynamic interaction of

what it means to be safe physically and emotionally, psychologically and

socially, is what gives this narrative and its particular interplay of stories,

integration into the life-story of the teller. Gayle’s narrative makes it obvious

that stories of birth are not singular moments in time. Birth narratives draw

together aspects of a person’s life to become a meaningful way in which

individuals make sense of their new identities in relation to previous ones (Frost,

2007: 5). Inside her narrative are several other stories relating directly to the

birth, but also relating to her childhood, her family’s history, her

characterisation, and her belief systems. Home births, framed around birth as an

intrinsically healthy physiological process with concurrent emotional import,

significantly shifts the way birth is approached, framed and performed

(MacDonald, 2006; Carter, 2009).

Part of the complexity in Joy’s narrative comes from the difficulty of aligning

the present moment with a projection of that moment. Home is a socially and

culturally interactive space, which although it is private, is intruded upon in

many different ways. Joy’s narrative draws our attention to what in a home birth

is actually more important than a lack of disturbance. Home is powerfully

binding because of the ways in which we interact with those things that are

personally, culturally and socially meaningful. In the in-depth interview

following the narrative Joy says ‘home for me is a very warm and personal

space…..there needs to be stuff that I can touch and look at and be inspired by’.

In her dream sequence, she begins a recalibration process that helps resolve both

the inner and outer disconnect, highlighting the elements of a socially caring

environment that feed back to the safety, security and self-worth of the

labouring woman. As her imagined reality of birth becomes aligned with the

reality of life unfolding around her, there is a sense of deep satisfaction in the

personalisation of her space and the attentiveness to her wellbeing by those

around her.

Less than a year after birthing their children the women in this study had had

time to process and merge disparate identities into an integrated self, embedded

into a wider network of significance. The personalised nature of the care these

participants received and their successful reconciliation of disparate identities

34

and realities is a powerful indication of their ability to maintain an intact

subjectivity during and immediately after birth. The nature of how birthing

women know what they know clearly centres on a relational matrix of meaning.

Relationality as contingent and context specific either enables or constrains the

factors that afford women choices during labour, birth and narrations of home

birth. Presenting a narrated subjectivity that deftly negotiated and reconciled

interference, these women claim a social and emotional currency that is both

abundant and adept. In choosing a social environment where care is relationally

maintained, subjective representations of purpose, strength and inspiration are

gained through symbiotic interaction. Seeing the self in relation during a home

birth affords reflection, recovery and discovery of that which is most

meaningful, including ‘ways of knowing’, all of which mutually encompass

what matters most.

These home birth narratives showcase how reconciling and negotiating the

actual birth experience with narrative constructions of birth generates greater

connectivity and an embodied wisdom. Really being safe featured in social

environments where qualities of relating sustained an ‘emotional resonance’

with self-assuredness and steadfastness. As the kernel of the home birth

experience, being safe is the container in which continuously unfolding,

fluctuating birthing subjectivities reconciled incoherence and interference.

Negotiated relationally, a level of authenticity can be realised at home that

encompasses both disconnect and connection in the process of birth. The middle

class women in this study were coaxed, through social environments of care, to

listen within, to voice their concerns, to trust themselves and their bodies and to

let themselves be supported. By being confirmed as a person with faults and all,

caring environments render meaningful those choices which affirm women’s

capacity for full responsiveness. As such, home births make possible a holistic

response to the encounter with birth, which validates choosing care, to claim

different ways of being with birth and new social structures where knowing,

caring and responsibility are shared horizontally.

The nature of the way in which these interviews were held meant that although

the narrators seldom speak directly of their identities as mothers, it was being

performed and lived as the narrative construction took place. Coming into being

at the time of birth is not only the new born, but a mother too. Social

environments of care encourages us to recognise the way necessary skills are

imparted to new mothers that empower them through a significant life transition.

Many women feel their competence as mothers is strengthened when they are

allowed to trust their intuitions and trust their bodies innate knowing. The

importance of which is stated by Barbara Rothman in Edwards (2005: 225)

when she notes that birth is not only about making babies it “is also about

35

making mothers – strong, competent, capable mothers who trust themselves and

know their inner strength”.

Limitations

This project was limited in several ways, most concerning of which was the self-

selective nature of sampling through facebook. The willingness of this study’s

participants drew attention to the eagerness with which most of these women

told their stories. Perhaps they likened their own agenda – to get more women to

choose home births - to mine. Or, more likely, they were women already

comfortable with the outcomes of their births, who were proud of themselves

and thus willing to reveal deeply personal narratives. In addition, having utilised

social networking, there is the chance that they may have felt compelled or

pressurised into sharing their stories. For these and any number of other reasons,

my chosen participants’ narratives impact substantially on the findings of this

study. In fact, the inclusion of women only, limited this project. The relational

nature of the care that was so important to these women’s choices suggests that

further research into home births should include men, midwives and doula’s

contributions to and perspectives on social environments of care. Finally, this

research is limited by its focus on middle class women. Women with varied

racial, class and other social backgrounds would make the findings more

applicable in multi-cultural contexts.

Conclusion

Home births account for a relational dimension of birth, in which social

environments of care, established as a feature of labour and delivery, influence

how women exercise control and negotiate choice. The birth narratives here

presented draw our attention to the way in which social environments of care are

enduring; creating and sustaining the conditions necessary for integration of the

self and healing of disjuncture. The inter-connectedness of people and place in

an environment that reflects belonging and meaning, validates the self.

Subjective perceptions of self are maintained through continuous relating,

continuous support and continuous care where embedded relationships sustain

the idea of an uninterrupted self. The uninterrupted birth is thus an idea that

works in synchrony with narrative constructions of the self, whereupon narrators

can claim wholeness and wellness, significant to their subjectivity. In effect,

expanding an understanding of home births that needn’t refute interference but

proposes ways of ‘caring’ that circumvents interference.

36

Uncaring, conversely understood, is not only detrimental to women’s birthing

subjectivity, but more importantly, is exposed as an ethical issue of critical

importance for maternal health. Particularly in a system which is over-

medicalised for the rich and under-resourced for the poor, women’s birthing

preferences and needs often fail to be prioritised. Yet this paper suggests that the

interests which promote and support social environments of care are the basis

for ensuring universally dignifying and honouring experiences of birth. The

controversy over who controls the power in birth, shown to be intimately tied to

the possibilities for healing birthing selves and empowering women, has far

reaching ethical implications. The distribution of health ‘care’ resources in a

highly unequal medical context is a form of professional misconduct which

subordinates certain women’s interests at the expense of others. Expectations of

and desirability for social environments of care on the other hand are

accountable to every woman’s birthing needs, not solely the middle classes.

Environments of care draw attention to the reciprocal nature of humane acts of

care that impact on the collective through local, everyday social relations.

Homes, which are already a source of validation, comfort and security for

middle class women, reflect the qualities of care that generate containment and

continuous relating during the shattering and unstable subjective experience of

birth. Home births are not only affordable, their resources are more accessible,

and their service portable, but they afford autonomy for birthing women, their

families and midwives alike. Women in this study were shown to take command

of their own birth processes. They made choices reflecting the need for

intimacy, safety, connectivity and agency to be intrinsic to empowered birthing

subjectivities. By choosing care, home birthers provides a lens through which to

scrutinise and critique birthing practices and to demand socially caring

environments as an integral aspect of the health of themselves, their babies and

their communities. Where neither the public nor the private sector are presently

fulfilling such needs, user demand for alternative, out of hospital settings for

birth must precipitate such change.

Relational experiences of care, which are felt and maintained, in connection to

people, place and space are not restricted to home births. Social environments of

care are easily transferable and they impact profoundly on the ability to

empower birthing subjects. Environments of care that sustain meaningful inter-

personal interactions, uphold spatial climates conducive to psycho-social

engagement with issues of health and wellbeing. Thereby prioritising a form of

holistic care to transcend interference and imposed limitations. Where caring

facilitates healing, it provides an experiential basis from which to come to know

what it means to be human. By adjusting both physically and psychologically to

interference in home births, women author stories of childbirth in ways that

37

highlight how social environments of care act as the foundation for sustaining

humane, meaningful, life-affirming experiences of birth.

The participants in this research project have shown that stitching together an

integrated identity, to account for the disruptive nature of birthing subjectivities

is a meaningful way women make sense of themselves. Birth, as a particularly

powerful moment in time, brings to light the way social identities are made and

remade, over time, and in an instant. This paper has shown how the narrative

undertaking allows women to gain subjective knowledge and insight into their

own shifting identities. The value of these narratives are therefore embedded in

the creative endeavour, where to reflect and present a reality is not necessarily to

assume its truth, but to claim a position that may ordinarily be out of reach.

Their resultant narratives joined together selves which construct their identities

as mothers, lovers, daughters, sisters, and wives into a continuously connected,

coherent sense of self. Where the psychosocial aspects of the birth setting

validates and affirms the psychosocial nature of birth - principally narrated in

this research project relationally and contextually - then there’s no place like

home in which to give birth.

38

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