Perceptions of risk: How they influence women's and health professionals' choices
The need to ensure the survival of the species by offering pregnant and labouring women special protection has been expressed in primitive human societies through elaborate rituals and superstitions, and in contemporary society, through the provision of antenatal and intrapartum care by health professionals. Modern maternity services tend to highlight the medical risks of pregnancy and birth. Women, however, may place such risks in a broader context which includes risks to their emotional wellbeing and therefore, to their capacity to bond with their baby. Given current understanding of the importance of the first 1000 days of a baby's life, women's desire to have a labour that does not jeopardise this early relationship, is entirely logical. While both health professionals and women are dedicated to ensuring the safety of mother and baby, their definitions of ‘risk’ may sometimes lead to women's decision-making being contested and the need for ‘negotiation of disagreement’
Physiologically and culturally, women are programmed and supported to provide an optimum environment for their unborn baby. Animal studies suggest that raised levels of progesterone during pregnancy provide a natural anti-depressant (Molina-Hernández and Téllez-Alcántara, 2001); its calming effect promotes a slower pace of life, and underpins the nesting instinct that inclines mothers-to-be to stay close to home and to people they know and places they perceive as safe, such as the maternity hospital. Pregnancy rituals found in every culture are driven by a desire, both at the level of the individual and society, to keep the pregnant woman and her unborn child, safe. What constitutes ‘risk’ is defined culturally and according to how advanced a particular society is in relation to its access to technology and the sophistication of its health care services.
Superstition is rife in pregnancy, but its basis is evolutionary. For example, native American women may be ‘taken to the water’ at the start of their pregnancy to bathe in waters imbued with herbs that protect the child against harm; special blessings may be bestowed on African women of certain tribes to protect them and their unborn children against malevolent spirits (Vincent Priya, 1992). While such rituals may seem unusual, many cultures in advanced societies have their own practices and superstitions driven by the primeval need to minimise risk and promote the safety of the mother and baby. In the UK, some women have been known to not eat strawberries during pregnancy to avoid their baby having a birth mark. Furthermore, women and men in antenatal classes may express a wish not to talk about caesareans because doing so may increase their likelihood of having one. Superstition represents the commitment of the community to the survival of the race, and the commitment of the mother to the survival of her child. It is part of what the psychologist, Donald Winnicott (1958), described as, ‘primary maternal preoccupation’.
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