Fundamentals of Midwifery: A Textbook for Students (30 page)

Women & Health
52 (8), pp. 788–803.Walsh-Gallagher, D., Sinclaire, M., McConkey, R. (2012) The ambiguity of disabled women’s experiences of pregnancy, childbirth and motherhood: A phenomenological understanding.
Midwifery
28, pp. 156–162.Williams, C., Alderson, P., Farsides, B. (2002) What constitutes ‘balanced information in the practitioners’ portrayals of Down’s Syndrome?
Midwifery
18, pp. 230–237.Witham, G. (2012)
Child Poverty in 2012 It Shouldn’t Happen Here
. Manchester: Save The Children.World Health Organization (2013)
Female Genital Mutilation
http://www.who.int/mediacentre/factsheets/ fs241/en/Zola, I. (1977) Healthism and disabling medicalization. In Illich, I., Zola, I., McKnight, J., Caplan, J. (eds),
Disa- bling Professions
. London: Marion Boyars.
Chapter 4‌
Psychology applied tomaternity careJulie Jomeen
University of Hull, Hull, UK
Lynda Bateman
University of Hull, Hull, UK
Learning outcomesBy the end of this chapter the reader will be able to:

identify the main theoretical models of psychology

discuss why the study of psychology helps to understand behaviour or individual responses toa given situation

recognise how psychology can help midwives relate to the women in their care and theirfamilies

recognise that midwifery practice can be enhanced by understanding psychology.
Introduction
Psychological health is important with respect to how we function and adapt. Its relevance tochildbearing women is clear when we acknowledge the significant transition and adaptation that women go through in their journey from conception through to motherhood. Understand- ing psychology in relation to pregnancy, birth and the postnatal period will afford midwives insight into the complexity of a woman’s experience and enable a more perceptive considera- tion of her emotional needs. Midwives are key to assuring the quality of women’s experiences across the perinatal period and hence can be central to women’s emotional health and wellbe- ing. How they communicate and interact with women can have both momentous and enduring consequence. This chapter will explore the study of how psychology can help midwives relate to the women in their care and their families.
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/midwifery
Defining psychology‌
Psychology is concerned with the thoughts, feelings and motivations underlying behaviour.
Psychology is the scientific study of behaviour and mental processes which emerged as a dis- tinct discipline around 150 years ago (Hewstone et al. 2005). There are many diverse sub-fields62 within psychology and whilst it could be argued that all these sub-fields relate to childbearing women, midwifery and maternity care provision in some way, some have a more direct andlucid relevance. These include:
Developmental psychology:
Change in behavioural and mental processes over the lifespan.
Social psychology:
The reciprocal influence of the individual and their social context.
Family psychology:
The family as a system and the relationships within that system.
Abnormal psychology:
The nature and development of abnormal behaviours, thoughts and feelings associated with distress or impaired functioning that is not a culturally expected response to an event.
Health psychology:
The identification and psychological causes and correlates of health and illness, psychological aspects of health promotion and prevention and treatment of disease.Psychology is a combination of specialities which place differing degrees of emphasis on understanding varying elements of the person and potentially make‘
psychology a wide-reaching subject with rather fuzzy boundaries
’ (Hewstone et al. 2005, p. 5). The five major historical approaches to psychology will be described, which have led to the evolution of many of the different sub-fields of psychology, including those described above. More contemporary approaches, including social constructionism and feminist psychology have also been high- lighted as valuable within a maternity care context (Raynor and England 2010). Feminist approaches emphasise how most of the influential theories within psychology are based on the study of men and then applied to women. Men’s behaviour becomes the standard against which women’s behaviour is judged, ignoring the role of socially constructed ideas of women and their place within society and as mothers. The social constructionist paradigm takes into account the effects on a person of society, culture, politics, environment and economics. Ways of talking about the world vary, but so do subjective experiences of living, which are constituted in and from those ways of speaking. Psychological knowledge is socially, culturally and hence historically specific.An understanding of different approaches within psychology can meaningfully contribute to our understanding of women’s psychological responses to pregnancy, birth and early motherhood.
Theories of psychology
To acknowledge the importance of psychology to midwifery it is important to look at psycho-logical theories and how they can be applied to clinical practice. While midwives are not expected to replace the work of psychologists, psychiatrists, therapists and counsellors, they need to have grounding in psychological theories to enable them to engage with women and their families to support them and enhance their effectiveness when confronted with challeng- ing situations. Five major approaches to psychology are discussed below together with their impact on psychological understanding.
Social constructionist approach‌‌‌‌‌
This is not further explored in this chapter; for further reading see Crombie and Nightingale (1999)
Social Constructionist Psychology
.
Behaviourist approach
The Behaviourists theorised that behaviour could be changed by conditioning and reinforce-
⁶³
ment of behaviour. The famous‘Pavlov’s dog’ is an example of conditioning changing behaviour. When an individual is rewarded for a behaviour, it will impact positively on the individual and will strengthen the behaviour (positive reinforcement: Skinner 1976). A conditioned change of behaviour requires a process of association. For example a baby learns that smiling at the mother is rewarded with attention, therefore will continue smiling to gain more attention – the behaviour has been
positively reinforced
by the attention; the baby is
conditioned
to smile and associates smiling with reward. Moreover, there is benefit for the mother as when she gives attention to her baby she too is rewarded by smiles.
Freudian approach
Freud was the founder of psychoanalytic psychology which has impacted on all psychological theory. Freud defined three basic structures of personality – the id, the ego and the superego (Stevens 2008). He proposed that unconscious, destructive behaviour, when analysed and brought into consciousness could be resolved. For example, a woman continually fails to attend the antenatal clinic at the General Practitioners (GP). When questioned by the midwife, the woman discloses that the ‘smell’ of the GP surgery reminds her of an uncomfortable experience as a child: being chastised by her mother for incontinence (due to a recurrent kidney infection) in front of the GP. The smell of the surgery brings back uncomfortable memories and thus the woman does not attend her midwife’s appointment.
Cognitive approach
Cognitive psychologists by contrast are interested in the scientific study of the mind, in particu- lar, the elements of thinking and reasoning, language, learning and memory, perception, atten- tion and consciousness. For example, a midwife may observe that a woman’s pulse is elevated following birth and a trickle of blood exits from the genital tract. The midwife calls for help and will ‘automatically’ commence uterine palpation and administer an oxytocic preparation, as she is cognisant with the predisposing factors of a post-partum haemorrhage (see Chapter 16: ‘Emergencies in midwifery’, where postpartum haemorrhage is discussed in more depth). Her behaviour is not based on positive reinforcement or unconscious memory; it is a function of acting from memory and reasoning whereby she has the‘data’ on how to manage a post-partum haemorrhage and acts accordingly.
Humanistic approach
Humanistic Psychology developed by Carl Rogers and Abraham Maslow is a ‘softer’, less analyti- cal and rationalist approach and heralded a move from analytical psychology to therapeutic person-centred psychology. The emphasis in person-centred psychology is that the individual is valued for who they are, without judgement and are accepted unreservedly (Rogers 1961). Thus three key conditions emerge: empathy, congruence and unconditional positive regard, which are an essential aspect of midwifery practice.
Bio-psychological approach
The final psychological approach is bio-psychological, which incorporates neuroscience and psychology, noting the impact of neurobiology on psychology (Pinel 2011). This approach
marries the biological response with the psychological response and examines the biological reasons for behaviour. Thus a woman’s behaviour can be impacted by neurological phenomena which may not have a rational basis. An example is the function of the endocrine system whereby a lactating woman can experience an oxytocin-mediated milk-ejection reflex merely by thinking of her baby. The biophysical response is triggered by thought alone and not by the baby sucking‌64 at the breast, which is the normal activator of the endocrine response during lactation.A bio-psychosocial model recognises that psychological health is best understood through the combination of physical, psychological and social factors, rather than working to a medical model aimed at identifying and categorising disease. This model acknowledges the importance of an interdisciplinary approach, the complexity of the constructs being defined and the unique- ness of the childbearing experience, thus aiding the conceptualisation of psychological health in the perinatal period.
Summary
Notwithstanding the psychological theories above, it is also important to note that the woman is situated within a social and cultural context. The woman’s perception of herself within her socio-cultural context will inform and impact on her decision-making during her childbearing experience. Midwives’ practice within a cultural context determined by local and national guide- lines and their individual experiences are also societally mediated, sometimes in conflict with personal beliefs which potentially can create tensions in practice.Midwives will bring their own psychology and socio-cultural influences to the maternity setting and the challenge to midwives is to develop self-awareness and sensitivity to those influences and the concomitant influence on women.
Psychology and public health in maternity care
Public health is concerned with helping people to stay healthy and protecting them fromthreats to their health. Government policy seeks to support people to be able to make healthier choices, regardless of their circumstances, and to minimise the risk and impact of illness and adverse health outcomes. Health psychology considers the relationship between health and illness and between the mind and the body. Its approach reflects the bio-psychosocial model that health and illness are the product of a combination of factors including the biological (genetics), behavioural (lifestyle, stress, health beliefs) and social (family/social support and cultural influence). The individual is not merely the passive victim of some external factor but has individual responsibility for their own health behaviours.Marks et al. (2005) suggest that this first requires a definition of health and have amended the World Health Organization’s definition of health to account for what they see as missing elements. They define health as ‘