Homebirth advocacy and self-awarenessHomebirth advocates display a startling lack of self-awareness. It's not that they are unaware of themselves. Quite the contrary. They are obsessively focused on themselves, their feeling and their needs. They lack self-awareness because they fail to realize that their feelings and needs are restricted to themselves, and do not mirror the feelings and needs of other women. There is a tendency among homebirth advocates to consider themselves as models for other women, and believe as if they the right to speak for other women. It never even occurs to them that what they want is merely their personal preference, not a universal standard adopted by all women.
That accounts, in large part, for the contempt in which homebirth advocates hold other women who are not as "educated" as they are. Leave aside for the moment the fact that homebirth advocates are generally among the least educated people around when it comes to childbirth issues, since most of what they think they "know" isn't actually true. They are sure that there is one and only one valid way to approach having a baby, and that is to demand information and control.
In an interesting study, Rhetoric versus Reality: Exploring Consumer Empowerment in a Maternity Setting, researchers Geiger and Prothero investigate the different ways that women plan for childbirth. They point out that the woman who wants to control the entire experience is uncommon, and what she demands from the midwifery and obstetric professions is not what most women want.
They describe Leah, the controlling consumer:
... Leah is a very active consumer who desired to be in complete control of her pregnancy and labour. To achieve this consumer sovereignty she went to great lengths to gather information from various sources and to build up intense relationships with her service providers. From the outset, she researched carefully which hospital to have the baby in and chose the one she felt would best suit her needs for having a "natural childbirth"...People like Leah know what they want. What they don't realize is that other women don't want the same things. The authors explain:
Leah wanted to know about everything that was happening throughout her pregnancy, so that any decision making would ultimately be based on complete knowledge of all available options and final decisions would rest with her as an empowered and informed client... This information provided her with a very specific idea of how she wanted things to be... [E]mpowerment for her translated into the ability to control the service process throughout, using her knowledge to ensure the service provided to her was the one that would most allow her to achieve her objectives of a natural birth.
Leah had briefed her husband extensively about what type of labour she wanted and she was relying on him as a proxy agent to make sure this happened:
'...I said to him Cian if you don’t advocate for me I will kill you. If they come near me with an epidural even if I’m saying get me the epidural, get me the epidural, and you say get her the epidural, I will kill you.'
... Leah ... reflected most on her relationships with the service providers. She worked incredibly hard at her relationships with all of the service providers she encountered because she strategically calculated the importance of all those who would be involved in helping her achieve her dream childbirth...
... In her desire to remain in control of the situation, Leah sometimes appears to be a highly confrontational character to those caring for her...
Indeed, a couple of Leah’s relationships with midwives became difficult. She felt that the service providers, in her eyes a mere instrument to facilitating her dream birthing experience, brought “too much personality” into their jobs. She knew she depended on them to realise her dream maternity experience...
Thus, across our research participants, Leah was the woman for whom empowerment translated most readily into control. She accumulated a great amount of information and developed and nurtured relationships with all types of service providers to ensure that her voice would be heard and heeded, and the pregnancy and labour would develop as she wished...
... [C]onsumers have vastly different ways in negotiating empowerment in a maternity setting. Roth (1994) ...stresses that "empowerment is facilitated when consumers have a comprehensive understanding of a health issue" and that "consumers feel in control by maintaining awareness and currency, facilitated by using easily obtainable and understood information sources". What our study shows, however, is that some women during their pregnancies may actually feel empowered by having less information — while they may have the ability to obtain and to utilise information, they actually choose not to do so if this proves less stressful and/or worrying. All four women presented here were highly educated and could have garnered considerable knowledge to allow them to make informed choices of their "ideal" birth should medical reasons not dictate another course of action; however, only Leah actively sought to be in a position to do so in order to control the process. Two of the other participants, Martina and Alice, used their knowledge to build a trusting relationship with their service providers, while Emer decided not to gain information that may leave her more frustrated and worried than necessary with her service provision...In summary:
Likewise, this study has confirmed a suggestion made by Wathieu et al. (2002) that what we conventionally understand as "consumer empowerment" — process control — can easily lead to cognitive overload and anxiety, especially when confronted with complex and novel situations. In this study, this was clearly the case for all of our participants, who devised different strategies to deal with their anxieties and to become empowered even if they chose not to exert control...
The literature talks of empowered consumers needing to take responsibility for the outcome of the choice process. Given the high stakes involved in a maternity situation, it is hardly surprising that to take such responsibility causes great anxiety for new mothers and their partners and may help explain why some women chose to become a passive patient rather than an active agent — though being passive to them was empowering.
Our study adds to the literature on consumer empowerment by showing that consumer control and empowerment are by no means the same. Empowerment is thus a much more complex phenomenon than often portrayed in the literature and it is very much a subjective experience that can range from highly active and controlling to reliant and passive.
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