“Babies come when they are ready”: Women’s experiences of resisting the medicalisation of prolonged pregnancy

Abstract

Being pregnant beyond one's estimated due date is a relatively common experience and requires complex decisions about whether to induce labour or wait for spontaneous onset. We report a qualitative study undertaken in the UK in 2016. We interviewed fifteen women and eleven more took part in an online focus group. Using thematic analysis, resistance to the medicalisation of prolonged pregnancy was identified as a strong theme. Drawing on the work of Armstrong and Murphy (2011), we identify both conceptual and behavioural resistance in the accounts of women who accepted, delayed or declined induction of labour. Experiential knowledge played a key role in resistance, but women found this was devalued. Some healthcare staff used risk discourse to pressure women to comply with induction protocols but were unwilling to engage in discussion. The social context provided further pressure to produce a baby 'on time', with induction normalised as the way to manage prolonged pregnancy. Online spaces provided additional information and support for women to question the medicalisation of prolonged pregnancy. We end by considering the implications for policies of choice and agency in maternity care as well as the need for additional social support for women who are 'overdue'.

Women's Perceptions on the Use of Video Technology in Early Labor: Being Able to See

“…13 Clinical implications for widespread uptake of video calls in early labor support a philosophy around the normality of birth, including spontaneous labor. 23 Supportive and shared interaction between the woman and the intrapartum care provider in early labor and communication throughout pregnancy unencumbered by biased risk discourse 33 are prerequisites to feelings safe and confident in the realm of early labor in the home environment. Whether women will develop self-efficacy for birth solely with video calls in early labor is unknown; video calls may be insufficient.…”

Reproductive governance and the affective economy

“…Roberts and Walsh (2019) report on their UK study exploring cisgender women's experiences of being “overdue” in the context of medical discourse and practice that abnormalises “prolonged pregnancy”. This is despite the reality that being pregnant for longer than what is medically expected or constructed as “normal” is a fairly common event (Adeniji & Akinola, 2013) and therefore within the normal variation of pregnancy duration .…”

“…Providers’ devaluation of their embodied knowledge resulted in the women feeling pressured and coerced to deliver soon or else accept induction, and resulted in them feeling irritated, devalued, dismissed and unacknowledged as experts. As a result of healthcare workers’ repeated framing of induction as the “moral” and “responsible” choice to make, the women in the study “felt they were being accused of recklessly putting their babies at risk” (Roberts & Walsh, 2019, p. 50) by delaying or refusing induction. Thus, Roberts and Walsh’s (2019) article visibilises how fear, guilt, and shame are mobilised within/through normative medical discourses’ construction of “prolonged pregnancy” as a health risk requiring induction of labour.…”

“…As a result of healthcare workers’ repeated framing of induction as the “moral” and “responsible” choice to make, the women in the study “felt they were being accused of recklessly putting their babies at risk” (Roberts & Walsh, 2019, p. 50) by delaying or refusing induction. Thus, Roberts and Walsh’s (2019) article visibilises how fear, guilt, and shame are mobilised within/through normative medical discourses’ construction of “prolonged pregnancy” as a health risk requiring induction of labour. The authors’ paper demonstrates that normative medical discourses and attendant practices serve to regulate not only the duration of pregnancies but also how pregnancies come to an end, with important affective consequences for pregnant people's experiences of pregnancy and childbirth.…”

“… 4. The percentage of pregnancies lasting longer than 41 weeks may vary by hospital, country, and region, with Roberts and Walsh (2019) citing 20.1% of all pregnancies in NHS England hospitals for the period 2015–16. Global estimates vary as well, with figures of 1.5–10% (Kortekaas et al, 2015) and 4–19% (Moradan & Nejad, 2012) being quoted.…”