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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