Fundamentals of Midwifery: A Textbook for Students (22 page)

Chapter 3‌‌
Sociology applied to maternity careMary Beadle
University of Hull, Hull, UK
Sarah Wise
Diana Princess of Wales Hospital, Grimsby, UK
Learning outcomesBy the end of this chapter the reader will be able to:

identify relevant sociological perspectives

define the terms gender and sexuality

explore socially constructed concepts

discuss the process of socialisation within families and society

examine health, illness and wellbeing as concepts.
Introduction
The NMC (2009, p. 26) state that midwives must be able to:
. . . contribute to enhancing the health and social wellbeing of individuals and their communi- ties’ and ‘practice in a way which respects, promotes and supports individuals’ rights, inter- ests, preferences, beliefs and cultures . . .
This chapter identifies the knowledge necessary to undertake this role. It explains some of the key sociological theories and how these could relate to maternity care. This will assist in develop- ing a sociological perspective and applying this to childbearing women and their families.
Overview of sociological perspectives
When studying sociology it is important to have a basic understanding of the theories behindthis area of study. However, this is not a chapter on the theories of sociology and therefore it is
Fundamentals of Midwifery: A Textbook for Students
, First Edition. Edited by Louise Lewis.© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd. Companion website: www.wileyfundamentalseries.com/midwiferyrecommended that further reading is undertaken; this chapter aims only to apply some of the key sociological concepts to maternity care. As a way to start this process you should focus on a few of the key sociologists and their main ideas. These should include:

Karl Marx –
class
43

Emile Durkheim –
division of labour, religion

Erving Goffman –
self in everyday life

Harriet Martineau –
study of institutions

Talcott Parsons –
sick role

Ivan Illich –
medical power

Max Weber –
social change – capitalism and religion

Anthony Giddens –
formation of social structures and identity

Simone De Beavoir –
feminism

Judith Butler –
doing gender

Sylvia Walby –
patriarchy

Peter Townend –
poverty
.
Further reading activityRead about the main ideas from these sociologists in:Giddens, A. (2009)
Sociology
, 6th edn. Chapter 3, Theories and perspectives in sociology, pp. 68–105. Cambridge: Polity.Bradby, H. (2012)
Medicine, Health and Society
. Chapter 2, Social theory and the sociology of health and illness, pp. 2–40.Hutchison, J. Parker, M. (eds) (2012)
Key Themes and Concepts in Applied Sociology
. London: Pearson. Mik-Meyer, N. Obling, A. (2012) The negotiation of the sick role: General Practitioners classification of patients with medically unexplained symptoms.
Sociology of Health and Illness
34 (7), pp.1025–1038.Giddens, A. Sutton, P. (eds) (2010)
Sociology: Introductory Readings
. Cambridge: Polity Press.The following websites will also be useful:http://www.newworldencyclopedia.org/entry/Sociology http://www.sociosite.net/topics/sociologists.php http://www.biography.com/people/groups/academics/sociologistsWhen looking at these sociologists views think about how these are relevant to healthcare.
Definition of society
Sociology has been defined as ‘
the scientific study of human life, social groups, whole societies and
the human world
’ (Giddens 2009, p. 6). The theory of social construction is also an important factor to discuss, as this has applications to healthcare and understanding childbearing within communities and cultures. Social construction is the idea that ‘
social reality is the product of interactions between individuals and groups
’ (Giddens 2009, p. 38), rather than something that is just natural. In this way gender is something that tends to be viewed as natural, as it is to do with our physical appearance, but how we behave and how society relates to us depending on whether we are men or women is something constructed by our society. Each society has rules and beliefs which their members are expected to adhere to, with consequences for breaking these rules. These are often termed as ‘social norms’; these change over time and may develop
and adapt to different circumstances within society. An example of this would be what is classed as a normal family structure; this has changed significantly in some societies but not in others. These messages can be found in government policies and institutions; religious and cultural influences can also have significant influence. The reason why these issues are important to44 midwives is the impact that they can have on the lives of women and their families.
Activity 3.1 Think about what you would class as social norms.
The family
The family is a key institution within society and therefore has implications for the development of people’s individual identities and beliefs. As McKie and Callan (2012, pp. 15,16) identify: ‘
families are the oldest and most enduring form of social grouping
’. They are ‘
formed, dissolved and reconfigured
’. There have been many changes over the last decades in family structures; these relate to the often termed ‘ideal’ family of a mother, father and two children. There are now many different types and make-up of families which are common and acceptable within society and the communities in which they live (see Figure 3.1). These include single-parent families, stepfamilies, children living in more than one family and couples living together but not married. Same-sex families are now more common but are not accepted by all sections of society.The increase in divorce, separation and decline in marriage has also had an impact on the makeup of families. Different types of families have had an impact on the health and wellbeing of family members and the arrangements in which women give birth. Technological advances have also led to further complexities in relationships within families, for example; artificial insemination by donor, in vitro fertilisation, egg donation and surrogacy (see Chapter 5: ‘Parent- hood’, where variations of families are explored in more depth). This has changed the biological relationship to parents, in that there may be more than one family that a child belongs to, and there may be no biological, only a social connection to their family.
Figure 3.1
Variations in family structures.
There is a lack of clear definition for the different types of family which present within society; sometimes only terms such as traditional and non-traditional family structures are used (Farrell et al. 2012). These terms are not very helpful, as they can mean different things to different people. The key issue for midwives and other healthcare workers is to be aware of the diversityof family structures and the implications this can have, namely, the challenges and positive
⁴⁵
elements for the women and families they work with. It is essential not to make assumptions about relationships within families, as this can lead to inappropriate care and use of language, resulting in miscommunication and a loss of trust.There are processes which happen within families which impact on the members’ identities. James and Curtis (2010) explore the concept of ‘family displays’; these are termed as ‘everyday activities’ in which family members communicate to each other and to those around them, that they are a family (James and Curtis 2010). This could be in the ways families communicate, where they live, their diet and habits. One of the key ways that this can occur is through the sharing of names; this is usually the last name or surname, which is passed down from genera- tion to generation and is a way of signifying that this person belongs to this family. There can also be the use of specific names within families; this is particularly the case with boys, with many members of one family having the same first name. This tradition has been affected by the reduction of births within marriages, as the baby does not automatically take their father’s surname unless they are named on their birth certificate. The non-traditional family can also lead to complexities in surnames, with children within the same family having different fathers and therefore surnames, as well as changing their surnames. This is effectively identified by Davies (2011) when one of the participants in the study had four surnames in the family, which was the norm for those children. This can have implications for midwives in that the baby’s surname is not necessarily the one that is expected. People from outside the UK and other com- munities and cultures may have completely different naming systems which midwives need to be aware of, to be able to provide culturally sensitive care.
Activity 3.2 Can you think of a family display relevant to your family?The characteristics of a ‘family’ relate to a formed identity, some form of economic contract, in which babies are born to form the next generation of that family, within which domestic and care work is undertaken (McKie and Callan 2012).There are events within families which can have a negative impact on family members includ- ing children and women. These can include: