Risk resistance: constructing home birth as morally responsible on an online discussion group

Multilevel structures and human agency in relation to email consultations: A strong structuration theory analysis of the Danish general practice setting

In recent years and throughout the developed world, policymakers have encouraged the implementation of digital patient-clinician interaction. Our focus is on the Danish general practice setting where email consultations were implemented as a mandatory service in 2009 and now constitute 21% of all consultations in general practice. Drawing upon strong structuration theory (SST), our analysis sets out to explore how email consultations are represented in structures on macro, meso and micro-levels and how the interplay between structures and agents plays out with respect to possible alignments, tensions and adjustments. We analyze data from policy documents on the macro and meso-levels, data from clinics' websites (meso-level) and data from interviews with GPs and patients (micro-level) (n = 53). Our findings show that the introduction of email consultation as a new health technology is a key site for development in email consultation practice, professional boundary setting and adjustments within the doctor-patient relationship. Our findings thus demonstrate that email consultation can be considered a dynamic component of a socio-technical network rather than a static medium for simple health transactions or information delivery. Based on these findings, we recommend that, for future implementation of patient-clinician digital communication it is important to investigate the multiple sources of influence on telecare practices and to see its intended users as agents who actively shape their own care motivated by opinions, relationships and values.

The role of pandemic-related pregnancy stress in preference for community birth during the beginning of the COVID-19 pandemic in the United States

BACKGROUND

The COVID-19 pandemic introduced unparalleled uncertainty into the lives of pregnant women, including concerns about where it is the safest to give birth, while preserving their rights and wishes. Reports on the increased interest in community births (at home or in birth centers) are emerging. The purpose of this project was to quantitatively investigate psychological factors related to this birth preference.

METHODS

This study included 3896 pregnant women from the COVID-19 Pregnancy Experiences (COPE) Study who were anticipating a vaginal birth. COPE Study participants were recruited online between April 24 and May 15, 2020, and completed a questionnaire that included preference with respect to place of birth and psychological constructs: fear of childbirth, basic beliefs about birth, pandemic-related preparedness stress, and pandemic-related perinatal infection stress.

RESULTS

Women who preferred a community birth, on average, had less childbirth fear, had stronger beliefs that birth is a natural process, were less likely to see birth as a medical process, and were less stressed about being unprepared for birth and being infected with COVID-19. In multivariate models, higher stress about perinatal COVID-19 infection was associated with greater likelihood of preferring a community birth. The effect of perinatal infection stress on preference was stronger when preparedness stress was high.

DISCUSSION

Women's birth preferences during the COVID-19 pandemic are associated with psychological processes related to risk perception. Community births are more appealing to women who view being in a hospital as hazardous because of the pandemic. Policies and prenatal care aimed to increase access to safe in-hospital and out-of-hospital birth services should be encouraged.

"You Can't Ignore a Number This Big": Gender, Risk, and Responsibility in Online Advocacy for Women's Brain Health

Alzheimer's disease affects more women than men and has therefore been highlighted as a women's issue. However, there is much debate regarding the nature of this gap, with some studies pointing to sex/gender differences in longevity to explain the disparity. Against this background of empirical uncertainty, we ask how online women's brain health campaigns position women as specifically at risk of developing the disease. Using a multimodal approach, we examine how these platforms relate womanhood to risk, prevention, and responsibility. Four main themes emerged: risk quantification, risk management, risk dispersion, and the gendering of risk. We confirm previous studies that identified a dual discourse in which Alzheimer's is represented as both a catastrophic threat and as a fate that individuals can and must prevent. We find that both constructions are intensified on women-oriented platforms compared with nonspecific websites. Ethical implications of the individualization and gendering of risk and responsibility are discussed.

Drawing the Line between Sick and Healthy: Normality Constructions in Health Communication Contexts

In this paper we examine how traditional views of normality are negotiated, indorsed and resisted when talking about children with heart defects. Having as a starting point an ethnographic project that aimed to study knowledge construction when being pregnant or having a child with a heart defect, we focus on argumentation put forward by clinicians and parents in order to understand the forms that normality takes in relation to children's health and illness and the way that it is constructed argumentatively and linguistically. More specifically, we draw data from recorded doctor-patient consultations, ethnographic interviews and entries from family blogs and forums and focus on those instances where normality is negotiated as a means of providing a medical consultation or of taking and motivating decisions about the child's health and everyday life. The analysis is conducted by identifying content and logical topics in the data and showing how constructions of normality and alternative conceptions are constructed in discourse. Discourses are additionally related to discursive, semiotic framing and the realization of norms. Our results highlight a duality that is being painted both in the clinicians and in the parents' discourse when negotiating the illness and the accompanying risks in the child's everyday life. Some of the traditional norms being re-constructed and re-negotiated in the data are those of stigmatization, diversity, responsibility and freedom of choice.

Home as a place for giving birth-A circumpolar study of the experiences of mothers and midwifes

This article explores what home birth mothers and midwives say about the birth experience and the interaction between mother, partner and midwife. It is based on an explorative empirical study of the narratives of seven home birth mothers and the experiences of five midwives. The authors examine how these subjective experiences can help us to understand the phenomenon of home birth. The article is grounded in a philosophy of place and feminist theory, understood within a health promotion framework. Home birth manifests itself as a place-based esthetic experience characterized by gender, body, nature and culture. The participants spoke of the significance of giving birth at home. The authors discover that giving birth at home involves celebration, togetherness and ontological security. It also encompasses a broad understanding of risk, power structures, responsibility and co-determination. Openness about the challenges of home births can boost the position of home birth among both clinicians and the general public.

Coping with the stigma of home birth: Strategies of engagement and disengagement

Background

Home birth in most developed countries is stigmatised. Negative discourses frame women planning home births as risk mothers who put their desire for a particular birthing experience above the health and safety of their children. As a result, one of the primary challenges home-birthing women face during pregnancy is how to cope with this stigma.

Participants and procedure

This study was conducted in the upper Midwest region of the United States with women who were planning home births with midwives. Eleven women participated in the study. Data included in-depth interviews, participant-observation field notes, and content from one participant’s blog. Data were analysed using inductive content analysis.

Results

Participants coped with home birth stigma in three ways: (1) avoidance, (2) engaging in an education campaign, and (3) focusing on a family tradition of home birth. These responses represent both disengagement and engagement approaches to coping. Nine participants exhibited one dominant coping strategy: three relied on avoidance, three on an education campaign, and three on family tradition. Two participants used more than one approach. Both of these participants used avoidance and family tradition.

Conclusions

Home birth stigma is a source of chronic stress for women who choose to give birth at home. Women cope with this stress in a number of ways. Interventions to increase women’s coping resources and processes may be helpful. Changing the environment through efforts to destigmatise home birth may reduce the overall stress experienced by home-birthing women and improve their wellbeing.