Cuerpo y ontología: La muerte perinatal y su duelo en el panorama tecno-científico del sistema sanitario

Abstract

This study takes the body (of mother and child), the technoscientific hospital landscape and professional ritual as the locus of an endeavour to understand the embodied experience of perinatal death, in order to better comprehend how alternate understandings and ontologies of motherhood, personhood and bereavement emerge during care enactments. Grounded in a descriptive and ethnographic approach the research analyses data from the entries of 22 members of a pregnancy loss support forum and 10 narrative style interviews. The research traces embodied experience from pregnancy, through diagnosis to the spatialised experience of the hospital, including the birth, postmortem contact and disposal of the corpse. Bounded by the sudden destruction of ontological security many of these women experience an existential crisis that results in a destructed stigmatised self. The research explores how overly medicalised obstetric care enacts understandings of perinatal death and bereavement that further problematizes postmortem relationships, creating toxic identities and embodied selves. Conversely, woman-centred midwifery that takes relational and social understandings as a basis for care can create the material conditions of possibility for a restoration of confidence in carnal self and a reconstruction of social bonds and order. Assembled through practice, discourse and policy, these bodies are individually, socially and politically enacted, but they are also multiple, mutable and enfolded assemblages of nature and culture. The research proposes that healthcare practice would benefit by considering natural stillbirths, just as contemporary obstetrics advocates natural childbirth. KEYWORDSPerinatal death, stillbirth, pregnancy loss, bereavement, hospital care, ontology, motherhood, personhood, hospital care, qualitative research. RESUMENEste estudio considera el cuerpo (de la madre y del niño) y el entorno tecno-científico como lugar paradigmático para analizar la experiencia tras la muerte perinatal, con el fin de comprender como se desarrollan ontologías alternativas de la maternidad, la personalidad y del duelo. La investigación analiza las entradas de 22 miembros de un foro de apoyo a la muerte perinatal y 10 entrevistas narrativas. El articulo aborda la experiencia asociada al embarazo hasta la experiencia con el espacio físico del hospital, incluyendo el nacimiento, contacto posparto y la disposición del cuerpo. Delimitado por la destrucción repentina de seguridad ontológica estas mujeres experimentan una crisis existencial que se traduce en un yo deconstruido y estigmatizado. Exploramos la manera en que la atención obstétrica excesivamente biomédica promulga comprensiones de la muerte y el duelo perinatal que problematizan aún más las relaciones posmortem, creando así identidades encarnadas tóxicas, y por tanto exacerbando el duelo. Por el contrario, la atención centrada en la mujer y liderada por la comadrona puede crear las condiciones para una restauración de la confianza en uno mismo y la maternidad, y una...

Prevalence and Mode of Birth in Late Fetal Mortality in Spain, 2016–2019

“…For the period studied, according to the National Institute of Statistics, the number of late fetal deaths was 4141 total dead fetuses, which is equivalent to a rate of 2.7 × 1000. Taking into account the rate of underestimation of cases (around 7%) [18,19], if a percentage increase of 5% were applied, a conservative estimate of the rate of late fetal death in Spain for that time period would be 2.8 × 1000.…”

“…It is important to point out that it was the parents or relatives who registered the variables, which accounts for missing data in some of the variables; for example, the number of weeks of gestation. In fact, it is estimated that between 2010 and 2015 the underreporting rate in Spain for stillbirths of more than 28 wg was 7.6% [18,19].…”