Body Trust: Excerpts from Midwife Robyn’s Thesis

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Included here are excerpts about body-trust in pregnancy and the table of contents from:

Does the Elective Primary Cesarean Section reflect a lack of body-trust in women of contemporary society?

by Robyn M. Brancato [Ozovek]. A thesis project submitted in partial fulfillment of the requirements for the degree of Master of Arts in Bioethics and Medical Humanities, Department of Internal Medicine, College of Medicine, University of South Florida. Major Professor: Lois Nixon, PhD. Submitted: April 24, 2006.

Excerpt #1, pages 57-58:

‘During pregnancy, the body undergoes major physical, mental, and emotional changes different than any other… At this major transformative and transitional period, women can benefit from gaining or maintaining a sense of physical attractiveness, as this may have been important to self-perception before conception…Improvements in physical fitness, strength, endurance, flexibility, muscularity, and self-worth enhance a woman’s ability to physically and psychologically labor and birth her child. Parturition is a deeply psychosomatic event that requires a woman allow her body to execute body-specific movements necessary to birth. To be self-efficacious, a woman must possess, know and believe that she has the strength, endurance, physiological functioning, reflexes, sensation capacities and coping techniques to succeed. The principle of training specificity provides a framework for this…Positive mood and self-regard are essential to the success of the pregnancy. Research indicates that negative mood during pregnancy can predict fear of childbirth (Melender, 2002), and that fear of childbirth indicates a lack of self-efficacy for childbirth (Lowe, 2000).’

Excerpt #2, page 58:

‘ Social support is critical to pregnancy outcomes, affecting everything from immune function (Costanzo et al., 2005) to prenatal care to life adjustment postpartum (Morse et al., 2000). Moreover, lack of social support is a characteristic of women who fear childbirth. The potential of group movement programs during pregnancy as a means of increasing a woman’s social support and relationship formation, as well as providing a form of childbirth physical education, may be an untapped resource.’

Excerpt #3, pages 59-60:

‘ Movement activities may be necessary conditions to promote thriving during pregnancy. According to Orem’s self-care deficit theory (as cited in Walker and Grobe, 1999), thriving is a function of self-care: To thrive in a situation, a person must care for herself nutritionally, psychosocially, and in lifestyle. “Self-care is a human regulatory function that individuals must…perform for themselves or have performed for them…to maintain life; to keep physical and psychic functioning and development within norms…and for integrity of functioning and development” (p. 172). This requires an “ability to acquire…knowledge about self-care…and to operationalize it” (p. 221). Similar to Orem’s self-care, Cowlin (2002) notes, “the self-efficacy of persons with extensive experience of their bodily sensations in physical activity affects how they use this information to improve their performance or achieve their goals” (p. 121).  Movement activities for childbirth increase self-efficacy, self-trust, autonomy, social support, decrease fear of childbirth, increase life adjustment skills and self-regard, and positively affect many aspects of physiology during pregnancy, all of which enhance the outcome of mom and offspring; and they teach a woman how to care for herself – the behaviors she needs and the way to perform this care – during this major life transition. Could movement activities for childbirth increase women’s self-efficacy and self-trust, and, in the process, enhance the well-being of mothers and babies? If movement activities are necessary components to thriving in the pregnancy period, should we not make them standards of prenatal care? For now, these questions remain unanswered, but evidence indicates it may be possible.’

Table of Contents

INTRODUCTION 1

HISTORY 5

The Prehistory of Reproduction 5

The Secularization of Midwifery 6

The Rise of the Profession of Medicine and the Technological Revolution 9

The Twentieth Century 12

MEDICAL LITERATURE ON EPCS 13

Risks and Benefits – Overview 13

Pelvic Floor Literature 17

Urinary incontinence 17

Fecal incontinence 18

Sexual dysfunction 19

Confounding variables 20

Attitudes of Obstetricians 21

SOCIOBIOLOGICAL THEMES IN CHILDBIRTH 24

Social Nature of Women 24

Physician Influences 26

Genesis of physician support for EPCS 27

Fear of litigation 29

Convenience 30

Society’s Values and Images 31

Psycho-Social Factors 38

AUTONOMY 41

Self-Efficacy 41

Defining Autonomy 44

The Logic of Informed Consent and Bioethical Concept of Autonomy 45

BODY-TRUST 50

Defining Body-Trust 51

The embodied self in childbirth 51

Defining Body-Trust 53

Increasing Body-Trust for Childbirth through Movement 55

CONCLUSION 61

Tables and Figures 64

References 67

Additional References 84

About the author: Robyn M. Brancato Ozovek, CNM, MA, MS received her Nurse-Midwifery degree from Columbia University; MA in Bioethics and Medical Humanities from the College of Medicine, University of South Florida; and, BS in Exercise Physiology from Southern Connecticut State University. She is also the author of Brancato, et al. A Meta-Analysis of Passive Descent Versus Immediate Pushing in Nulliparous Women With Epidural Analgesia in the Second Stage of Labor, JOGNN, 37 , 4-12; 2008. She practiced at Brookdale Hospital and Norwalk Community Clinic, and she is currently raising two young sons. Her interests include home birth, breastfeeding issues and body trust related to women’s birthing choices.

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