Maria Zadoroznyj

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.

Birth and the ‘reflexive consumer’: trust, risk and medical dominance in obstetric encounters

The doctor–patient relationship has come under considerable scrutiny in recent research as a ‘site’ for the analysis of consumerism in medical encounters. The research reported in this article examines consumerism in obstetric encounters through an analysis of the birthing narratives of 50 women. The analyses reveal that there are clear, socially patterned variations in the character of the relationships between birthing women and their doctors. There is considerable evidence to support the notion of childbearing women as both consumers and as ‘patients’ in a medicalized encounter. There is also strong evidence that women’s use of maternity services is highly reflexive, and characterized by conscious ‘risk assessment’. These findings have important implications for the analysis of trust, risk and medical dominance in obstetric encounters.

Managing Sustainable Urban Water Reuse: Structural Context and Cultures of Trust

ABSTRACT Water scarcity in urban environments is an issue of increasing concern in Australia and many other parts of the world. Technological solutions include recycling municipal effluent, which can be treated to a standard suitable for nonpotable uses such as garden watering and toilet flushing. Successful operation of such solutions requires institutional arrangements for long-term management, as well as public awareness and cooperation to establish safe practices. This article reports on research undertaken at four case study sites in Australia and the United States and identifies the social and management issues important to the success of water reuse projects. The cross-national findings demonstrate that best practice in residential water reuse technology should be coupled with institutional and structural arrangements that inform and involve the public and provide transparent governance. It is suggested that this combination of technical and social structural elements will facilitate a sustained trust in, and acceptance of, water reuse.

I’m not dieting, ‘I’m doing it for science’: Masculinities and the experience of dieting

Abstract Despite heightened concerns about levels of obesity and overweight in Western societies, there is a relative absence of sociological research into the subjective experience of dieting, especially for men. This paper focuses on findings related to the male participants from a qualitative study of fourteen volunteers (six female and eight male) drawn from a larger clinical trial comparing two diet conditions. Semi-structured interviews were conducted in two stages to gain an in-depth understanding of the experience of dieting, and found that these men understood and practiced their dieting in different ways from the women, but also from each other, depending on their notions of masculinity. Some were eager to reframe their dieting in ‘more manly’ terms. The social support or sabotage received from friends and family is significant to these experiences of dieting. This paper discusses how men understand and practice dieting within the framework of gendered discourses and gendered relations that can make healthy eating hard to sustain.

Women's satisfaction with antenatal and postnatal care: an analysis of individual and organisational factors

Abstract: A local study of consumer views of maternity services was initiated because of major shifts in the patterns of maternity service provision and use in a metropolitan region. Women who had given birth to a live infant at one of four hospitals in and near the region in the 1991 calendar year were surveyed about their satisfaction with their antenatal and postnatal care. Questionnaires were sent to 866 women and 519 responded, for an overall response rate of 62 per cent; in the second stage of the study, in‐depth interviews were conducted with 50 of the women. Analyses were conducted according to the hospital and to individual sociodemographic characteristics. There were statistically significant differences in satisfaction according to womens sociodemographic characteristics and the type of hospital at which they gave birth. Women who were best off in terms of economic, educational and other social resources reported the highest levels of satisfaction. Analyses by hospital revealed important differences between different types of public hospital, and between public and private hospitals. The results suggest that changing some of the organisational features of antenatal and postnatal care provision may make a significant difference to womens experience of, and satisfaction with, maternity services; most of the organisational changes identified suggest an enhanced or extended role for midwives in the provision of antenatal and postnatal services.

Motherhood, Medicine & Markets: The Changing Cultural Politics of Postnatal Care Provision

In high-income countries welfare states play a crucial role in defining - and re-defining - what is offered as publicly provided care, and as a result shape the role of families, markets and the voluntary sector in care provision. Fiscal policies of cost containment, coupled with neoliberal policies stressing individual responsibility and reliance on market forces in recent decades, have resulted in the contraction of state provided care services in a range of sectors and states. There has also been widespread retrenchment in public health sectors across many countries resulting in policies of deinstitionalisation and early discharge from hospital that are predicated on the assumption that the family or voluntary sector will pick up the slack in the care chain. At the same time that this loosening of medicalized control has occurred, services to families with young children have become increasingly targeted on ‘at risk’ mothers through widespread population surveillance. To date, analyses of the implications of these important changes in care provision have primarily focused on health services and outcomes for birthing women and their newborns. In this paper, we make the case that post-birth care is a form of social care shaped not only by welfare state policies but also by cultural norms, and we suggest an analytic framework for examining some of the recent changes in the provision of postpartum care. We use examples from three developed welfare states - the Netherlands, Australia and Canada - to illustrate how variations in welfare state policy and cultural norms and ideals shape the provision of home and community based postnatal services.

A qualitative study of pharmacy nurse providers of community based post-birth care in Queensland, Australia

BackgroundReduced length of hospital stay following childbirth has placed increasing demands on community-based post-birth care services in Australia. Queensland is one of several states in Australia in which nurses are employed privately by pharmacies to provide maternal and child health care, yet little is known about their prevalence, attributes or role. The aims of this paper are to (1) explore the experiences and perspectives of a sample of pharmacy nurses and GPs who provide maternal and child health services in Queensland, Australia (2) describe the professional qualifications of the sample of pharmacy nurses, and (3) describe and analyze the location of pharmacy nurse clinics in relation to publicly provided services.MethodsAs part of a state-wide evaluation of post-birth care in Queensland, Australia, case studies were conducted in six regional and metropolitan areas which included interviews with 47 key informants involved in postnatal care provision. We report on the prevalence of pharmacy nurses in the case study sites, and on the key informant interviews with 19 pharmacy nurses and six General Practitioners (GPs). The interviews were transcribed and analysed thematically.ResultsThe prevalence of pharmacy nurses appears to be highest where public services are least well integrated, coordinated and/or accessible. Pharmacy nurses report high levels of demand for their services, which they argue fill a number of gaps in the public provision of maternal and child health care including accessibility, continuity of carer, flexibility and convenient location. The concerns of pharmacy nurses include lack of privacy for consultations, limited capacity for client record keeping and follow up, and little opportunity for professional development, while GPs expressed concerns about inadequate public care and about the lack of regulation of pharmacy based care.ConclusionsPharmacy based clinics are a market-driven response to gaps in the public provision of care. Currently there are no minimum standards or qualifications required of pharmacy nurses, no oversight or regulation of their practice, and no formal mechanisms for communicating with other providers of postnatal care. We discuss the implications and possible mechanisms to enhance best-practice care.

Timing of Return to Work and Breastfeeding in Australia

OBJECTIVE: To examine the effects of timing of return to work, number of hours worked, and their interaction, on the likelihood of breastfeeding at 6 months and predominant breastfeeding at 16 weeks. METHODS: A nationally representative sample of Australian mothers in paid employment in the 13 months before giving birth (n = 2300) were surveyed by telephone. Four multivariate logistic regression models were used to analyze the effects of timing of return to work and work hours, independently and in interaction, on any breastfeeding at 6 months and on predominant breastfeeding at 16 weeks, controlling for maternal sociodemographics, employment patterns, and health measures. RESULTS: Mothers who returned to work within 6 months and who worked for ≥20 hours per week were significantly less likely than mothers who had not returned to work to be breastfeeding at 6 months. However, returning to work for ≤19 hours per week had no significant impact on the likelihood of breastfeeding regardless of when mothers returned to work. Older maternal age, higher educational attainment, better physical or mental health, managerial or professional maternal occupation, and being self-employed all significantly contributed to the increased likelihood of any breastfeeding at 6 months. Similar patterns exist for predominant breastfeeding at 16 weeks. CONCLUSIONS: The effects of timing of return to work are secondary to the hours of employment. Working ≤19 hours per week is associated with higher likelihood of maintaining breastfeeding, regardless of timing of return to work.

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Governments are increasingly implementing policies that encourage early father-infant bonding. However, to date, research has not systematically examined fathers’ perspectives and experiences of early bonding. Using a social constructionist embodiment perspective we argue that paternal bonding is best conceived as a process of repeated, embodied performances that are shaped by gendered parenting discourses. Drawing on 100 semi-structured interviews with a diverse group of Australian fathers of young infants, we argue that most men believe they are capable of developing early strong bonds. They assume that bonding is a product of spending sufficient time with a child, irrespective of the parents gender. In contrast, a sizable minority of fathers assert that physiology means fathers are ‘largely useless’ to very young infants, and tend to remain distant in the early months. We conclude that social policies promoting early paternal bonding must engage with and challenge gendered/physiological discourses.

Beyond birth: Women's concerns about post-birth care in an Australian urban community.

BACKGROUND The provision of post-birth care in the community is changing substantially in many parts of Australia including Queensland, where there has been a burgeoning of clinics in private retail outlets such as pharmacies. Little is known about womens experiences of post-birth care in community pharmacies, nor of how their experiences compare with those in publicly-funded Child and Family Health Clinics (CFHC). AIM To provide qualitative insights into womens experiences of the different forms of post-birth care in the community, and identify where improvements could be made to service provision. METHODS A purposive sample of mothers of infants aged under 12 months was recruited to maximise variation in the use of private and public postnatal care services. Semi structured interviews were conducted with fifteen mothers whose antenatal, birthing and post-birth experiences varied across public and private sectors and birthing providers. RESULTS Concerns about lack of information and psychosocial support following discharge from hospital were widely reported, particularly by women who had given birth in a private facility under the care of a private obstetrician. Women used both pharmacy nurses and CFHCs. Pharmacy nurses were generally preferred for their accessibility, psychosocial support for mother, and continuity of care. However, these services are unregulated and without quality assurance mechanisms. Mothers found CFHCs regimented, focused on infant surveillance rather than support for mothers, and difficult to access. CONCLUSION There is a clear need for community post-birth care that will provide mothers with the information and psychosocial support they need. Currently, private, home-birth midwives and pharmacy nurses are providing women-centred care more effectively than nurses in publicly funded CFHC or GPs. This seems to be linked to continuity of carer, and to service priorities, resulting in inequities and systematic variations in the quality of post-birth care. Further research on this important health care issue is recommended.