Problematic Integration in Pregnancy and Childbirth: Contrasting Approaches to Uncertainty and Desire in Obstetric and Midwifery Care

Abstract

The experience of pregnancy is often accompanied by uncertainties with which mothers somehow have to cope. Uncertainty may be related to the health of the mother or baby, or how labor will be experienced, as well as longer-range issues, such as financial concerns and worries about being a good parent. Drawing on Babrow's (1992, 2007) PI (problematic integration) theory, this article explores the struggles that pregnant mothers face and the role that their practitioners play in these dilemmas. Particularly, this project examines obstetricians and midwives in an effort to discern how these providers differ in their confrontation of mothers' uncertainties.

ACKNOWLEDGMENTs

The author is grateful to Austin Babrow for comments on earlier drafts of this manuscript, and to the mothers and providers who shared their pregnancies and time in order to make this research possible.

Notes

¹Midwives vary in terms of education and the manner in which they practice. Certified nurse-midwives first become nurses, then receive midwifery training, typically as a master's degree (Rooks, 1997). Because their training comes from inside the medical community and they tend to work under the direct supervision of OBs, their practice is often more reflective of the obstetric model of birth, although there are exceptions (Rooks, 1997; Rothman, 1990). This study examined direct-entry midwives: One was apprentice-trained, and the other attended a school of midwifery. Both midwives in this study obtained their certified professional midwife credential by passing a test administered by the North American Registry of Midwives. Because certified professional midwifes receive their training from outside the mainstream medical community, their practice tends to conform more closely to the midwifery model as outlined in this article (Rooks, 1997).

²Although the biopsychosocial model (Engel, 1977), which acknowledges the role of psychosocial variables in health, is widely recognized, such variables are considered important only to the degree that they impact the physical, objective body (Zook, 1993). Thus, the physical domain remains of central concern.

³Because midwives embrace the notion that pregnancy and birth are normal, natural processes, they employ few if any medical interventions (Davis-Floyd & Davis, 1996; Parratt & Fahy, 2003). When used, these interventions tend to be low-tech and noninvasive (e.g., breathing exercises; encouragement to change positions and walk during labor; and hydrotherapy, including showers and tubs; Larson & Rao, 1995; Parratt, 2002). It has been argued that the need (or perception of a need) for medical technology is supplanted by the midwife's provision of support for a laboring woman. Rather than checking in periodically to assess progress, a midwife typically stays with the woman, providing constant support for her throughout labor (Johanson, Newburn, & Macfarlane, 2002; Kirkham, 1993; Parratt, 2002).

⁴All names have been changed to protect participants' privacy.