research
Concepts of ‘normal’ and ‘natural’
Jackie Topp, a disabled mother, advocate and researcher from Northampton, UK, compares two case studies from her qualitative research with disabled women becoming mothers, exploring concepts of 'normalness' and 'naturalness'. Interviews were conducted and analysed for PhD research at The Open University.
A current focus in midwifery studies is to consider the concepts of 'normal' and 'natural' pregnancy and childbirth.
This article compares two disabled women's accounts of their experiences of becoming mothers. Analysis draws out considerations of what is normal and natural and suggests that having a normal and natural experience of becoming a mother is not just about how much clinical intervention may be experienced. Instead, this article suggests that for disabled women normal and natural experiences are reflected in attitudes and understandings about disability, and whether adequate and appropriate maternity support is provided.
Katherine's story
Katherine has lived with rheumatoid arthritis since her teens. She can walk only very short distances and wears splints on her hands. Although unable to work she is a very active person and is involved in local disabled people's user groups. Katherine is positive in how she is seen in the world and how she lives her life. She has no difficulties with talking about how she identifies herself as a disabled person and clearly states “I've got a disability … I rule my disability, it doesn't rule me”.
When talking about her pregnancy, Katherine says she sought advice from medical professionals she knew and trusted. This happened both before and during the pregnancy. She wanted to know about the risks she and her baby might encounter and how she could safeguard them both.
Although Katherine did not want an elective caesarean section she did not consider a home birth. Instead she appeared to want the whole hospital experience with all the safety that she felt this would offer.
She talks about how her community midwife assisted with this. “The midwife was brilliant. We talked a lot about pregnancy and she asked me how I was coping and things like that. She made notes and put them on my notes at the surgery but she also went to the hospital and put them on there. She wanted to know what help and assistance I wanted when I went in to have my baby; were there any gadgets or aids I'd need while in the hospital?”
Katherine's approach to becoming a mother may be said to be very clinically based and was highly organised. Yet at no point did she consider that her impairment negatively affected the events and experiences of her becoming a mother.
Her account suggests that for her a normal pregnancy was one where she was able to ask questions, be given evidence-based answers, make her own choices and be supported to be in control. Katherine experienced these; risks were identified according to the way she identifies as a disabled person – her status as a disabled pregnant woman was acknowledged as normal, and she found adequate support for her impairment needs. Katherine's experience of becoming a disabled mother may therefore be said to have been normal and natural.
Charlotte's story
Charlotte's story contrasts greatly with Katherine's. Charlotte has multiple sclerosis (MS) but is able to walk short distances and take care of herself. When asked how she sees herself as a disabled person she says
”Rather than people seeing me at a weak point using a walking stick, I would rather stay in and just not go out because when people see your weaknesses they use them against you to get at you”.
This suggests that, unlike Katherine, Charlotte does not easily identify as a disabled person. Instead she appears to see her impairment either as something of which she feels ashamed or something that makes her feel particularly vulnerable.
Also, unlike Katherine, Charlotte's pregnancy was unplanned. She did not know she was pregnant until about 16 weeks. She then visited her general practitioner and said she was immediately recommended to have a termination. Apparently the general practitioner had told Charlotte that “[the pregnancy] would be detrimental to my health and the actual birth could endanger my life. Apparently the MS wasn't doing my health any good and realistically how could I cope with having a child because I had MS.”
This experience may have caused Charlotte to feel that becoming a mother was neither normal nor natural for someone living with MS. This, together with the way Charlotte appears to identify with her disability, could have influenced her to comply with her general practitioner's recommendation for the termination. However, she cancelled the appointment and continued with the pregnancy. She says “So I thought, 'I'll just deal with it when it comes', that kind of attitude”.
Like Katherine, Charlotte also talks about her experience with her community midwife. She says “I'm not saying she wasn't supportive, it was a case of like it was a completely new kettle of fish for her. She'd never dealt with anybody who had MS and was pregnant, so it was a brand new ball game for her, so she just tried to stick to what she knew on the pregnancy side”.
Charlotte seemed aware that her pregnancy was different for the midwife and felt her impairment needs were not being supported. This again suggests that for her becoming a mother was in some way not normal. This is further evident as she talks about her plans for giving birth. Charlotte says “I went for a natural birth, which didn't look as though it was gonna be possible anyway and definitely a home birth was out the question”. When asked why she had said this Charlotte replies “I honestly don't think they are used to us MS people having babies”.
Charlotte's experience of becoming a mother appears to have been negatively affected by having an impairment, not in a physical way, but in the attitudes she feels she experiences from others. Charlotte's account therefore suggests that for her the process of becoming a disabled mother was experienced as neither normal nor natural.
This analysis suggests that for pregnant disabled women the concepts of normal and natural may be less about whether or not they have a highly medical or a completely natural pregnancy and birth. For them, normal and natural experiences are embedded in two issues: first, feeling supported with their specific pregnancy needs; and second, having their individual impairment and disability issues acknowledged and managed without prejudice or ignorance.