Shifting Landscapes: Immigrant Women and Postpartum Depression

Utilizing an ethnographic narrative approach, we explored in the Canadian context the experiences of three groups of first-generation Punjabi-speaking, Cantonese-speaking, and Mandarin-speaking immigrant women with depression after childbirth. The information emerging from women's narratives of their experiences reveals the critical importance of the sociocultural context of childbirth in understanding postpartum depression. We suggest that an examination of women's narratives about their experiences of postpartum depression can broaden the understanding of the kinds of perinatal supports women need beyond health care provision and yet can also usefully inform the practice of health care professionals.     

Typologies of rural lay-health advocacy among rural women in Australia

BACKGROUND: Public health advocacy effects changes in health behaviors and outcomes through applying health promotion expertise to specific groups. Advocacy occurs through the provision of tools to empower those who are either experiencing, or at risk of, a particular health status. RESEARCH OBJECTIVES: Health-care experiences of women living in rural Victoria, Australia, were explored in the context of generally poor access to reproductive health services. Women's experiences are investigated within the theoretical framework of lay-health advocacy, i.e. relying on individual health care experience and knowledge to promote and improve the health care of others. METHODOLOGY: The study applied a qualitative design, and a self-identified sample of women was recruited through network sampling techniques. Fifty-seven women participated in in-depth interviews. RESULTS: Three types of lay-health advocacy emerged. Advocacy-seekers expected the researchers to use their experiences of poor health-care to educate health professionals to provide better quality care. Advocacy providers used their knowledge and experiences to take an active part in promoting the health-care of other women. Story-tellers expected their narratives to empower other women or unidentified social groups to feel less isolated in their health care experiences. DISCUSSION: In providing narratives of their health-care, women were critical of social inequalities facing people living in rural Australia. Lay-health advocates offer a cost-effective and appropriate option for reducing adverse health outcomes within resource-poor settings. Informed by women's narratives, we suggest strategies to enhance rural women's health-care.     

Negotiating control and meaning: home birth as a self-constructed choice in Finland

Each society has its own consensual understanding of birth and its determinants: caregivers, location, participants and loci of decision-making, which in the Western world are based on biomedical knowledge. However, two competing cultural models of childbirth, the biomedical/technocratic model and natural/holistic model, mediate women's choices and preferences for the place and caregiver in childbirth. This article explores the way in which these cultural models of birth and the existing practical possibilities for choices shape women's and men's understanding of home birth. Based on interviews with 21 Finnish women and 12 Finnish men, the reasons for and experiences of planning and building toward a home birth are examined through an analysis of birth narratives. The analysis focuses especially on the women's definitions of what is 'natural' and their relationship with health services where biomedical practices and knowledge are the norm. The analysis shows that the notion of 'natural birth' holds various meanings in Finnish women's narratives namely self-determination, control, and trust in one's intuition. I seek to demonstrate that just as the biomedical management of childbirth exhibits distinct cross-cultural variation, so also does resistance to biomedical hegemony, as such resistance is strongly embedded in the local socio-cultural situation.     

Giving birth in the hospital: childbirth experiences of Thai women in northern Thailand

In this article, I examine how Thai women perceive and experience childbirth in hospitals. The article is based on in-depth interviews with 30 women living in Chiang Mai, Thailand. The women's narratives reveal that childbirth was managed within the medical system. The women believed that safety was the primary reason for their choice of birth in the hospital. Women's embodied experiences with hospital birth reveal the "passivity" discourse; women accord total trust to their doctors and very rarely question the many routine procedures in hospitals. It seems that in northern Thai hospitals the involvement of women's partners or their significant others is kept to a minimum. Of interest among postpartum care provided in Thai hospitals in the north is the use of a spotlight to help heal the episiotomy wound. This is an adaptation of Thai traditional confinement practices in the era of modernity. The use of a spotlight in hospital not only provides the women with symbolic ritual but also is believed to assist them in the healing process. Women in general were satisfied with postpartum care received during their hospital stay, except for rooming-in practice. The data suggest some differences between rural poor and urban middle-class women in terms of hospitals of birth, the opportunity to have a family member at birth, and so on. It is clear that middle-class educated women are able to exercise their choices and control over their childbirth experiences much more than rural poor women. I argue that care provided to women during birth needs to take into account women's emotional and subjective experience so that sensitive birthing care can be achieved. This will only make childbirth of many women a more positive one.     

Sociocultural context of women's body image

In our society, women's bodies are the locus of both increasing rates of obesity and body dissatisfaction. While these trends may seem contradictory or to result from each other, an alternative explanation is that they are both the products of an unfavourable sociocultural environment in the area of food and weight. Both body dissatisfaction and excess weight can seriously impact women's physical and emotional health. The strong cultural value placed on thinness, especially for women, unfortunately may take precedence over health. To effectively address the impact of women's body image dissatisfaction requires an understanding of the multiple contexts of women's lives. This study used a naturalistic paradigm to explore how women's personal and sociocultural context influences their body image. Forty-four non-eating disordered women ranging from 21 to 61 years old were interviewed twice using a semi-structured interview guide. Women's narratives revealed that body image is not a static construct, but is dynamic and fluctuates as women encounter new experiences and re-interpret old ones. The powerful and unconscious impact of the media on body image was mediated by women's internal contexts (self-confident and self-critical) and their relationships with others, such as partners and other women. Body image was not so much influenced by the nature of others' comments but interpretation of their meaning. However, health professionals' comments were typically not reinterpreted due to the health context in which they were given. While some women's narratives expressed their internalized sociocultural norms, others' described acceptance of their bodies following a process of reflection and empowerment. In light of these findings, efforts to improve women's body image, and by extension their health, can no longer only focus on diminishing the tangible power of industry and media, but must include transforming the social ties, practices and conventions in everyday relationships, including with health professionals.     

Social Class, Social Selves and Social Control in Childbirth

This paper analyses the birthing narratives of 50 Australian women to explore their representations of their birthing experiences. Through the analysis, issues of power, identity and control in childbirth are explored, particularly with respect to the major discursive categories framing childbirth. The birthing narratives of the women in this study revealed significant differences in orientation to first birth according to women's social class, but also revealed significant shifts in identity and empowerment with subsequent births. These findings differ significantly from existing accounts of power relations in childbirth, which have tended either to universalise women, or, in more recent post-structuralist accounts, to abandon the notion of socially structured differences between women altogether. The findings of this research indicate that social class has a strong effect in the shaping of identity, but that these differences can be transcended by the experience of childbirth itself, which is a critical reflexive moment in many women's lives.     

Negotiating care: reproductive tract infections in Vietnam

Through case studies of two women, this paper uses a taskonomy approach to analyze rural Vietnamese women's narratives of prevention, treatment and management of vaginal discharge to illustrate care seeking, health practice and the pragmatism of their action. The research is based upon ethnographic research undertaken by the author between 1995 and 1997 in a rural district in northern Vietnam. This exploration illustrates the complexities of women's rationalities and the web of influences upon their choices-the health seeking culture as practiced. The women's narratives are also placed within the broader context of gender, power and health systems that structure their decision making. The author discusses how social and economic resource factors influence the choices women make regarding when to begin treatment for vaginal discharge and where to seek care. She concludes that women use their understanding of the relationships between health, living conditions and diseases on a day-to-day basis and that the practice of managing vaginal discharge is mediated by concepts of body, self and the body politic in Vietnam.     

"We wanted a birth experience, not a medical experience": exploring Canadian women's use of midwifery

In this study I explore Canadian women's use of midwifery to examine whether their choice represents a resistance to the medicalization of pregnancy/childbirth. Through my analysis of the data I identified eight ways the women's deliberate decision to pursue midwifery care represented resistance to medicalization. In so doing, I demonstrate how women actively assert their agency over reproduction thus shaping their own reproductive health experiences. The outcome of their resistance and resultant use of midwifery was empowerment. Theoretically the research contributes to understanding the intentionality of resistance and a continuum of resistant behavior.     

Issues for South Asian Indian patients surrounding sexuality,fertility, and childbirth in the US health care system

BACKGROUND: In 1998 ethnic minorities comprised 28% of the US population, and India is the third most common country of origin for immigrants. Many recently immigrated South Asian Indian patients are seen in health care settings in the United States. To deliver health care effectively to these patients, it is helpful for physicians to understand common cultural beliefs and practices of South Asian Indian patients. METHODS: Two illustrative cases are reported. One author's observations of the care of pregnant and parturient women in India and similar experiences in our own office spurred a literature search of the cultural behaviors surrounding sexuality, fertility, and childbirth. A literature search was conducted in Index Medicus, Grateful Med, and the catalogue of the University of Pennsylvania Arts and Sciences library, using the terms "Indian," "South Asian," "male and female gender roles," "gynecology in third world," "sexuality," "sexual health," "women's health," "women's health education," "obstetrical practices/India," and "female roles/India." RESULTS: Issues surrounding sexuality and childbirth that arise during the US physician-South Asian Indian patient encounter might not correspond to the commonly held knowledge, beliefs, and behaviors of the US health care system. Common cultural beliefs and behaviors of South Asian Indian patients around sexuality and childbirth experience include the role of the individual patient's duty to society, the patient's sense of place in society, lack of formal sexual education, prearranged marriages, importance of the birth of the first child, little premarital contraceptive education, dominance of the husband in contraceptive decisions, and predominant role of women and lack of role for men (including the husband) in the childbirth process. CONCLUSION: Lack of understanding of the Indian cultural mores surrounding sexual education, sexual behavior, and the childbirth experiences can form barriers to Indian immigrants in need of health care. These misunderstandings can also lead to patient dissatisfaction with the health provider and health system, underutilization of health services, and poorer health outcomes for Indian immigrants and their families. For this reason, it is important to teach cultural issues during undergraduate, graduate, and continuing medical education.     

Japanese women's experiences from pregnancy through early postpartum period

Declining availability and accessibility of perinatal health care are emergent social concerns. Based on the Listening to Mothers-II (LTM-II) surveys, we describe a total of 20 Japanese women's perinatal experiences. Data were qualitatively compared with those of U.S. women, using a theoretical framework for evaluation of primary health care. Japanese women overcame their worries by engaging in healthy behaviors, accepting hardships such as labor pain, and receiving assurance from health professionals and modern technology. We found that while U.S. and Japanese women's perinatal experiences reflected their unique cultural values and social context, a cross-cultural universality of birthing women's experiences exists.     

Birth and social class: Northern Thai women's lived experiences of caesarean and vaginal birth

This paper, based on in-depth interviews with Thai women in Northern Thailand, contributes to a sociological understanding of women's childbirth discourses. The findings indicate that the lived experiences of birth differ between individual women. It clearly shows that social resources such as financial resources and education play a salient role in shaping the embodied experience of birth among women in Northern Thailand. Because of their 'everyday lifestyle', middle class women have more control over the experience of childbirth than that of the rural poor women. Middle class women are able to choose where to give birth, have access to private care and actively seek medical technology as a way to have control over their birth. Their material resources enable their choices. These choices seem to be denied to the rural poor women. But not all rural poor women are passive victims of their material resources. No matter how limited the resources women have, they use them. Hence, there are some poor women who actively seek birthing care that enables them to have more control. But regardless of their social positions (urban middle class or rural poor), obstetric interventions are commonly experienced, and most women perceive caesarean birth in a positive light. Several discourses are employed to explain these findings including women's interpretations of their lived world including risk and the medicalisation of childbirth in Thailand. Taking a feminist standpoint, I argue that differences between women need to be taken into account in providing care to women in childbirth so that sensitive and appropriate birthing care can be achieved.     

Roles, work, health perceptions and health resources of women: a study in an Egyptian delta hamlet.

Women's health needs can only be described and programs to address them implemented with an understanding of women's multiple roles and responsibilities. A life-cycle approach to examining women's roles and responsibilities provides a useful framework to achieve such understanding. This paper describes the results of a study conducted in a rural village in Egypt that examines the daily life experiences of women, their work, their family responsibilities, their health perceptions and their health resources. We argue that programs designed to address women's health needs must consider these critical aspects of their lives. This argument is based on the premise that women's health needs have been neglected and efforts to ameliorate this situation should be a top priority in the international health care agenda of the 1990s.     

Medicine, gender, and disability: disabled women's health care encounters

In this article I examine the intersection of gender and disability in the medical arena by considering disabled women's experiences of receiving health care in the United Kingdom. Drawing on the "social model of disability," I focus on the attitudes and practices of doctors. I use two sources of qualitative data: (i) 68 disabled women's narratives gathered in the United Kingdom in 1996-1997; (ii) interviews with 17 disabled women regarding their reproductive experiences in the United Kingdom. I suggest that disabled women health service users are at risk of experiencing oppressive medical practices because two forces of oppression appear to be frequently, and interactively, in play: patriarchy and disablism.     

"Jesus will fix it after awhile": meanings and health

There are many myths and stereotypes related to the health of people of color in the United States. Many research studies are done and statistics proliferate on the health status of non-dominant groups. Few studies attempt to understand the meaning systems of poor and working class African American women in relationship to health and health care. This study uses an ethnographic approach including narrative analysis of life history interviews in order to examine how the life experiences and belief systems of a small group of poor and working class African American women from a storefront church in Seattle, Washington, inform and influence the women's opinions and interactions with the dominant white health care system. This paper will examine specific dimensions of the women's belief systems and discuss how these beliefs are applied as the women interpret, confront and examine the meaning of health and the meaning of their own experiences in specific health care encounters. The women's belief systems, learned and reinforced within the context of their daily lives, enable the women to offer a unique critique of the health care system, as well as to maintain a powerful subjectivity in the face of an objectifying system, the dominant white western health care system.     

Japanese women's experience of childbirth in the United States

While Japanese people represent a significant and growing cultural group within the United States, little is known about the culture-specific needs of Japanese women who experience pregnancy and childbirth in this country. Five women participated in a study of Japanese women's experience of pregnancy and childbirth in the United States. The following thematic clusters emerged from the interview data: issues related to the maintenance of Japanese birth-related practices and traditions; comparison of the Japanese and U.S. health systems; language difficulties; and the need for support systems. This group of well-educated, medically sophisticated women regarded their experiences overall to be positive. Still, they identified areas of uncertainty and unfamiliarity of which health professionals should be aware in order to facilitate the negotiation of culturally congruent care.     

产褥期保健新模式的探讨

目的:探讨在医院月子中心“坐月子”新的产褥期保健模式下产妇各器官复旧的情况,产妇心理体验、新生儿体格发育情况。方法:以2004年4月~12月在我院月子中心“坐月子”的30名产妇(称现代月子)为实验组,同期分娩在家“坐月子”的30名产妇(称传统月子)为对照组,观察2组母婴情况。结果:实验组产妇在睡眠、心情愉快、母乳喂养、身体恢复方面比对照组好。结论:改变坐月子的模式,更加促进母婴健康。     

Unraveling the mysteries of timing: women's perceptions about time to treatment for cardiac symptoms

Women in the USA are at disproportionate risk of dying from a myocardial infarction (MI), of suffering disabilities following an MI, and of reinfarcting and dying within a year of their initial MI. Various explanations, including women's older age at clinical manifestation of coronary heart disease (CHD) and higher likelihood of co-morbidities, have been offered for women's heightened risk of poor outcomes. Less frequently, research has focused on examining women's prolonged time elapse between symptom onset and biomedical treatment, a phenomenon that renders women less likely to undergo lifesaving reperfusion strategies. [1] To explore factors and circumstances that may shape CHD time to treatment, 40 middle age and older women living in Kentucky, USA, half with diagnosed CHD and half with chronic conditions considered to be risk factors for CHD, participated in a series of in-depth interviews. While much of the existing CHD literature implicates individual responsibility as the determining feature in time to treatment, these women's narratives suggested that treatment decisions inextricably are linked to broader social and structural constraints. Such supra-individual forces that shape the CHD experiences of women include the social construction of "standard" cardiac symptoms based on male norms that ultimately confuse symptom detection, women's negative encounters with health care providers who discount their knowledge, the competing social demands women face when threatened by a serious illness, and structural barriers delimiting women's health care choices.     

GIVING BIRTH IN THE HOSPITAL: CHILDBIRTH EXPERIENCES OF THAI WOMEN IN NORTHERN THAILAND

In this article, I examine how Thai women perceive and experience childbirth in hospitals. The article is based on in-depth interviews with 30 women living in Chiang Mai, Thailand. The women's narratives reveal that childbirth was managed within the medical system. The women believed that safety was the primary reason for their choice of birth in the hospital. Women's embodied experiences with hospital birth reveal the “passivity” discourse; women accord total trust to their doctors and very rarely question the many routine procedures in hospitals. It seems that in northern Thai hospitals the involvement of women's partners or their significant others is kept to a minimum. Of interest among postpartum care provided in Thai hospitals in the north is the use of a spotlight to help heal the episiotomy wound. This is an adaptation of Thai traditional confinement practices in the era of modernity. The use of a spotlight in hospital not only provides the women with symbolic ritual but also is believed to assist them in the healing process. Women in general were satisfied with postpartum care received during their hospital stay, except for rooming-in practice. The data suggest some differences between rural poor and urban middle-class women in terms of hospitals of birth, the opportunity to have a family member at birth, and so on. It is clear that middle-class educated women are able to exercise their choices and control over their childbirth experiences much more than rural poor women. I argue that care provided to women during birth needs to take into account women's emotional and subjective experience so that sensitive birthing care can be achieved. This will only make childbirth of many women a more positive one.