I am a member of the Perinatal Mental Health New Zealand Trust (PMHNZ) whose vision is to : “improve outcomes for families and whanau affected by mental illness related to pregnancy, childbirth and early parenthood”. They produce a quarterly newsletter that includes information about research, training, workshops and courses, innovative projects and services, topics for discussion and stories. It was a privilege to share my research with other members in the February newsletter (pdf) and on this Women’s day it seems apt to share it with a broader audience.
One of my favourite stories that I would tell when we ran workshops in the nineties about postnatal depression was by Jack Kornfield. I would share this story and half the room would be in tears.
“There is a tribe in East Africa in which the art of true intimacy is fostered even before birth. In this tribe, the birth date of a child is not counted from the day of its physical birth nor even the day of conception as in other village cultures. For this tribe the birth date comes the first time the child is a thought in its mother’s mind. Aware of her intention to conceive a child with a particular father, the mother then goes off to sit alone under a tree. There she sits and listens until she can hear the song of the child that she hopes to conceive. Once she has heard it, she returns to her village and teaches it to the father so that they can sing it together as they make love, inviting the child to join them. After the child is conceived, she sings it to the baby in her womb. Then she teaches it to the old women and midwives of the village, so that throughout the labor and at the miraculous moment of birth itself, the child is greeted with its song. After the birth all the villagers learn the song of their new member and sing it to the child when it falls or hurts itself. It is sung in times of triumph, or in rituals and initiations. This song becomes a part of the marriage ceremony when the child is grown, and at the end of life, his or her loved ones will gather around the deathbed and sing this song for the last time.” A Path with Heart (1993, p. 334).
For me the message in this story reflects the importance of love, being loved by a community and the importance of acknowledgement. Painfully, however, it highlights the ways in which women’s experiences of maternity can be just the opposite. That is, they can feel isolated, disrespected and invisible. As a clinician, I’ve learned that there are ways in which we, and the system that we work in can make this most magnificent, sacred and profound time in a woman and her family’s life also one that is painful, one that leaves long lasting scars. Health professionals can cause harm even especially when we think we are doing good. As an academic for 13 years prior to which I worked as a clinician for 10 years, I am deeply interested in the issue of power and how professional frameworks of care can undermine women’s personal experiences.
This song has been the background soundtrack to my recently completed PhD. I used data from a study funded by the Families Commission and assisted by Plunket, where I talked to 40 migrant women about their experiences of becoming mothers in New Zealand. I also talked to Plunket nurses about their experiences of caring for women from ethnic migrant backgrounds.
My motivation for doing research was prompted by my clinical experiences. Several years ago I decided to make a move from working in mental health to working in maternity. As someone who had worked as a community mental health nurse I took a lot of concepts about my work in mental health into this new setting, for example, I believed that care should be client centred and driven, that services should fit around consumers of services and that taking time to be with people was important. What I found in the institutionalised setting of hospital maternity care and later community care was that some of the routine procedures that are administered in hospitals and in the community with good intentions had negative impacts and were oppressive especially for women who did not tidily fit into the mould for the factory style model that was in place then. The conveyor belt metaphor is apt given that women who were the wrong fit were viewed as a problem, as only a single way of becoming a mother was acceptable. I saw that staff were frustrated at the extra demands or complexity of working with ‘diverse’ women, they lacked resources like time and knowledge. In turn, I could see that women who valued particular kinds of social support, acknowledgement and rituals were not getting their needs met. It seemed like a situation where no one was a winner.
What I found out in my research was that there was a big gap in satisfaction among women who were familiar with the structure of maternity services in the west and women whose lives had been shaped by growing up in other cultural contexts. Fundamentally there was a schism in the ways in which birth was understood. To be simplistic, western modes of being a mother valued independence, autonomy, taking up expert knowledge and using it and being an active consumer. By that I mean the individualising of responsibility for maternity on the mother, to take up scientific knowledge through reading self help books and for the role of the partner to be a birth coach and the goal of birth to be “natural”.
This dominant Pakeha middle class model of being a mother clashed with other understandings of motherhood, where responsibility was more collectivised, so that embodied knowledge from cultural authority figures (mother and mothers in law) protected mothers and where a range of rituals and supports were available for the mother (including some which were also not necessarily helpful). Women who became mothers in New Zealand had to negotiate these two different models of maternity and come to terms with what they negotiated. However, in the context of an assimilatory maternal health system it was very difficult for women to maintain traditions that were important to them. For example many women were not supported if they wanted to bring in traditional foods with them or have support from grandmothers. Many of these encounters left migrant mothers feeling disempowered. Another important clash was the different philosophies and roles of professionals and mother in the context of midwifery models and medical models. Some women viewed birth as a risky process and wanted the reassurance of visualising technologies. The view of birth as a risky process clashed with midwifery models of birth as a natural process that women are physically prepared for but need encouragement and support with.
Conclusion How can we support all kinds of women with different values, beliefs and rituals around birth, to feel loved, nurtured, safe and supported? How can we give women who might be separated from their loved ones, support to access those values, beliefs and that will allow them to manage the transition into motherhood? Returning to the metaphor of singing, and the power of connection it engenders, how can we connect and support people who are singing different kinds of songs? Can we adjust our tone so that we can harmonise? Can new songs and rhythms infuse the songs we already know with new energy and possibility?
Having a baby in New Zealand without your support base http://www.mentalhealth.org.nz/kaixinxingdong/page/486- resources+dragon-babies+parents-stories