Problematic integration in pregnancy and childbirth: The experience of uncertainty, diverging expectation and desire, ambivalence, and impossibility in obstetric and midwifery care
Abstract
The purpose of this research was to conduct an in-depth study of the relationships that pregnant women have with their care providers, and how these relationships differed depending on whether the provider is an obstetrician or a midwife. This study employed Babrow's (1992, 1995, 2001, in press) Problematic Integration (PI) theory. Of particular interest was how these women and their providers jointly constructed uncertainty and other problematic integrations throughout the pregnancy, and how these constructions varied from obstetrician to midwife. Accordingly, the prenatal and postpartum appointments of four women (two seeing obstetricians, two seeing midwives) were observed and recorded, and in-depth interviews were conducted with the mothers and their providers. Through these observations and interviews, some distinctions among practitioners emerged with respect to how PI, particularly uncertainty, was confronted. Consistent with the literature, the physicians demonstrated a low tolerance for uncertainty, which was manifested in practices such as extensive testing and monitoring of their patients and exercising control through medical procedures to a greater extent. Conversely, the midwives were more tolerant of uncertainty, not requiring the same amount of information and control as did the physicians. However, all four providers sought uncertainty reduction; it was the paths to this reduction that varied. With respect to the joint handling of PI, all four women were satisfied with their providers' performance, but differences again emerged between the midwives and obstetricians. Both types of providers effectively helped women to cope with uncertainty as it related to a deficit of information. However, the midwives attended to uncertainty in a broader sense, addressing not just reducible uncertainty, but irreducible, ontological uncertainty. In the face of irreducible uncertainty, the midwives sought other methods to support mothers, including providing emotional support and helping mothers to address their evaluative orientations about the object(s) of uncertainty.
Degree
Ph.D.
Advisors
Babrow, Purdue University.
Subject Area
Communication|Womens studies
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