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    Plan détaillé Texte intégral Introduction Researching obstetric violence (OV) through the Gallery of Obstetric Experiences Artwork as a discursive trigger Expressing perceptions of violence on cloth The use of artistic expression in ethnographic inquiry – potentials and shortcomings Conclusion Acknowledgements Bibliographie Notes de bas de page Auteur

    Modos de Fazer, Modos de Ser

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    The Gallery of Obstetric Experiences: addressing perceptions of obstetric violence through ethnography-based artistic experimentation

    Catarina Barata

    p. 199-225

    Texte intégral Bibliographie Notes de bas de page Auteur

    Texte intégral

    Introduction

    1The Gallery of Obstetric Experiences1 is a project whereby women use artistic experimentation to interrogate, process and represent their experiences of obstetric violence (OV). Its aim is twofold: to constitute a body of creative depictions of birth experiences that can be used to interrogate and explore personal experiences of childbirth with the people who create them, and to foster public discussion on the issue of OV, through communication and engagement with wider and non-academic audiences. This chapter analyses some of the first outcomes of the Gallery to explore what artistic expression can tell us about experiences of obstetric violence, while looking at the initial process of constitution of the Gallery to critically consider the use of collaborative artistic methodologies in activist ethnographic inquiry.

    2The use of collaborative artistic methodologies in ethnographic research that has gained momentum in the last decades seems to assist anthropologists in finding ways to grasp the more subjective and hidden aspects of personal human existence. According to Pussetti (2018: 7), the use of art practices in fieldwork helps to explore the unspoken and grasp emotional, sensorial and internal imaginary worlds, as well as to communicate in a more effective way the multisensorial lived experiences. Artistic tools’ “ability of closing sensual gaps” (Pröpper 2015: 7) seem to offer valuable tools to help disclose intimate realms of the research subjects’ imagination and experience. Regarding visual methodologies, Banks (2007: 16) acknowledges the expressive powers of images as a way of enriching sociological analysis and argues for their value “in promoting exploration, serendipity and social collaboration in social research” (ibidem: 120). Within feminist art-therapy scholarship, Hogan (2008, 2015, 2018, among other writings) has systematically shown how image-making and reflection increase participants’ awareness and understanding of their birth experiences, validating difficult birth experiences and mediating stress. Following Sánchez Criado and Estalella (2018), I consider artistic expression as a “field device” for experimental collaboration, enabling the articulation of inventive ways of working together. My interlocutors turned epistemic partners – “companions sharing the endeavour of problematizing the world” (ibidem: 20) – actively engaged in the problematization of the research issue. In this chapter, I question the ways in which the materialization of memories and perceptions of obstetric violence in artworks reveal key aspects of the experiences that can be used for discussion and conceptualization about the subject matter. The works I discuss in this chapter resulted from a pilot group session for the making of art pieces that I organized within a video-art festival. The call for participants was promoted on Facebook. During the session, Monty Python’s sketch “The Miracle of Birth” (1983)2 acted as a discursive trigger for the sharing of birth stories. By analysing artistic expression as a way to provoke collective reflection, I assess art’s capacity as a discursive trigger, and an ancillary tool for processing experiences and communicating perceptions. Finally, I propose a reflection on the benefits and limitations of the use of participatory artistic methodologies in ethnographic research. Is artistic expression an effective “field device” for the elaboration and articulation of experiences of violence? What do the products of artistic creation tell us about perceptions of experiences of OV? 

    Researching obstetric violence (OV) through the Gallery of Obstetric Experiences

    3Obstetric violence is defined as the mistreatment of women during pregnancy, birth and post-partum and has been framed as a manifestation of structural gender violence and a human rights issue (Sadler et al. 2016; Šimonović 2019). It assumes many shapes, from overt verbal, physical or psychological abuse, to subtle coercion, such as the performance of interventions without informed consent (Bohren et al. 2015). What is ultimately at stake in OV is the violation of the integrity of the woman during obstetric care. It is usually related to women’s feeling of loss of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting their quality of life (Goberna-Tricas and Boladeras 2018). Besides being a consequence of the medicalization of childbirth, activists and scholars have more recently framed OV as a manifestation of structural gender inequality, i.e., women’s subordinate position in society when compared to men. Drawing on Bourdieusian and Foucauldian analyses of mechanisms of naturalization of gender inequality through symbolic construction, Sadler et al. (2016) argue for the need to acknowledge the links between this type of disrespect and abuse with wider social dynamics of inequality and uneven power between groups. In Šimonović’s assessment of OV as a global phenomenon (2019), OV is described as a type of treatment that expresses naturalized behaviours of structural violence against women in the sense that the institutional violence in maternity facilities is guided by a set of cultural assumptions and meanings that devalue and subjugate women, which strongly parallels the societal position of dominance of men.

    4Mistreatment or disrespect and abuse are used interchangeably in the literature when referring to OV and allude to treatment that disregards the multiple realms and needs of the woman in the setting of obstetric care. The term obstetric violence was coined at the beginning of the 21st century by Latin-American activists and still has limited public currency. It is mostly used within female reproductive rights activist circles, which are mainly constituted by privileged actors of white, middle-class origin (Vega 2018). Childbirth rights activism advocates for woman-centred and evidence-based care (Akrich et al. 2014). In line with the “engaged turn” that currently dominates anthropological production (Ortner 2019), I assume a role of critical engagement with real-world problems to research perceptions, discourses and representations of experiences of OV. My investigation is inextricable from my experience as an advocate for women’s reproductive rights, which informs my scholarly perspective. As an activist scholar, I feel the responsibility to produce results that the people I work with can relate to, recognize as their own, and use as it works best for them (Hale 2008).

    5In line with a global recognition of the worldwide prevalence of obstetric violence (Šimonović 2019), the commonness of the phenomenon in Portugal has been subject to wider attention in recent years (APDMGP n.d., 2015). Portugal has the second highest reported rate of medicalised birth in Europe (Euro-Peristat 2010; Fedele and White 2018: 608). Despite slight variations amongst different professional teams and health institutions, the setting of obstetric assistance in Portugal is quite homogeneous in enforcing a highly interventive approach, including the routine use of procedures that are controversial and associated with negative outcomes (ibidem). The traumatic3 impact which this prevailing type of obstetric care has had on women surfaces in birth stories shared in common talk and increasingly published online in social media, but women’s experiences of obstetric care in Portugal have seldomly been scrutinized in the social sciences, with very few exceptions (such as Rohde 2016; see also the edited volume by Fedele and White 2018).

    6The original goal of the artistic strand of my ongoing research project on perceptions, discourses and representations related to experiences of obstetric violence was to create an online gallery with works in any kind of technique and support created by women who self-identify as having experienced OV. Memories of traumatic experiences linger in the victims’ embodied sensations and interpretations, constituting the person’s sense of self through long-lasting multisensual and intellectual inscriptions, and the challenge was to find a means of depicting and communicating a complex sensorial experience. Inspired by the work of Hogan in addressing perinatal experiences though participatory art (2008, 2015, 2018 and others), I believed creative expression to be a good strategy to unblock feelings related to traumatic perinatal experiences. I hoped artistic means would allow an alternative to the logocentric tendency of our society through the expression of feelings and thoughts that might be difficult to convey in words. In the words of Hogan and Pink, “considering that the word cannot explain everything, and that art is a powerful medium” (2010: 171), visual methods drawing on therapeutic practices can be efficient “routes to interiorities” to assist us in understanding other people’s inner states (ibidem: 161). Through metaphor and symbolism, I believed participants would be able to effectively express their most inner (profound and hidden) feelings and thus disclose what might otherwise remain concealed, as Guillemin and Westall (2008) have explored in research on post-natal depression. Furthermore, the arts have communicative powers to captivate and impress messages upon viewers, and “visual images occupy an elevated place in memory” (Leavy 2015: 225). I am interested in exploring ways which enable us to grab the visceral and embodied dimensions of experience and convey them, without overlooking the shortcomings of this kind of approach within ethnographic inquiry.

    Artwork as a discursive trigger

    7I held the pilot session of the Gallery of Obstetric Experiences within an international video-art festival in a small village in southwestern Portugal. The group was summoned using two posts: one on the festival’s Facebook page and another on a local group’s page explaining that the aim of the workshop was to create art pieces based on the participants’ birth experiences. Eight women showed up, two of whom I previously knew and had directly invited, and two others brought their babies (under one year of age) along. An organizer of the festival was present as an observer. One of the participants was childfree, but identified with the subject because of personal experiences of gynaecological violence she shared with the group.4 Apart from her, who had come from Lisbon to attend the festival, all of the participants were residents in the village or nearby. Most were Portuguese, and one was born in the UK of British parents but raised in Portugal. One was Austrian and another was German, who had both been living in Portugal for some years and whose partners were Portuguese. 

    8I started by showing an excerpt of Monty Python’s film The Meaning of Life (1983), “The Miracle of Birth”,5 where a hospital birth is portrayed as a comical event where hospital staff behave randomly among massive and useless technology, while the woman giving birth is totally ignored. It is a caricature of the technocratic model of birth (Davis-Floyd 2018), where certain striking characteristics of the model, such as the patient as object, the authority inherent in practitioner and the supervaluation of technology, are exaggerated in order to create a comic effect. The caricatural nature of the scene provoked some comic relief, and participants were laughing and commenting on the surrealness of several details as we watched the sketch. Although the term obstetric violence was not yet in use when the film was made and the objective of the scene is to satirize hospital births in the UK back in the 1980s, it is, to this day, an eloquent portrayal of abusive behaviour and mistreatment of women at health facilities that we can relate to. Because of that, the film acted as a discursive trigger.

    9As soon as it was over, Júlia, a woman in her thirties, immediately commented: “but that is what happened to me!” She rushed over to tell us about her birth story, a “horror movie” where, among other things, she suffered the Kristeller manoeuvre.6 This changed the mood of the conversation, and in the following hour and a half, women shared their birth stories, made comments on what had happened, exchanged opinions about each other’s experiences, and theorized about the reason why the provision of care works this way. The flow seemed unstoppable and it was clearly more important, for everyone in the room, to talk about their birth stories rather than anything else. I reconciled myself to the idea of adapting my original proposal of art making. As time was running out and the babies were getting impatient, I distributed cloth diapers, asking each participant to take them home and create an intervention based on their birth experience, in whatever form they wished: it could be a drawing, written sentence, embroidery, collage, appliqué, patchwork, or whatever the imagination allowed. Why cloth diapers? It is an object widely used in Portugal by mothers and other caregivers. As such, it is a recognizable symbol of the baby. Cotton cloth has some physical properties which interestingly parallel qualities of babies. It is a delicate material which calls for fragility: it can be easily manipulated, cut, torn and destroyed. At the same time, it is rather strong: an all-purpose object, versatile and durable. It endures bodily products and excretions, such as milk, urine, vomit or excrement, so familiar to the work of care, and it acquires many shapes and functions as needed: napkin, hat, wrap or toy. The diapers I distributed had belonged to my two babies along the years and some showed stains from their long use. They were clean, but not immaculate. This was a deliberate choice of mine, as I found it enriching to give new life to an object no longer needed for its conventional usage, and aesthetically interesting to assume and incorporate the original stains in the artwork itself. I found its past life as utilitarian object would confer it added value, as if it had the power to embody the characteristics of those who have ever used it and carry an intrinsic value for all the utility it had served. The environmental benefits of reusing instead of commercially acquiring new material also appealed to me. I asked the participants to bring the diapers back to the festival site within a week, where we would meet to discuss the results. Of the eight women present, five embraced the challenge, including the two women I had met before (Ana and Laura). They were all aged between thirty and forty years old and had medium or higher education. Rita and Sara each had one child and they both worked in healthcare (a community nurse and a physiotherapist), Ana, a fashion designer, and Mila, a coach from Austria, had two children, and Laura, a full-time mother from the UK (but raised in the village since the age of ten) had three.

    Expressing perceptions of violence on cloth

    10During the second session, we organized our discussion around the works, giving the chance for everyone to share the ideas that presided to their creation. We looked at the results one by one, commenting on each other’s technical and conceptual choices, as well as creative processes. Theoretical discussions about obstetric violence spontaneously arose from the works, without the need for my intervention. I realized the participants had well-informed explanations for the phenomenon and our gathering was a prolific opportunity to share and validate them.

    11Most women chose drawing (Laura) or writing (Sara and Mila) with a pen, one chose cutting and appliqué (Rita), and another a combination of painting with stencil, sewing and tearing (Ana). The diapers’ contents varied, but interestingly enough, all but one employed some kind of wording (figure 1). “Group resonance”, i.e., the echoing of common themes through artworks that allows a “meta-analysis” of the emerging themes (Hogan and Pink 2010: 162) showed that the most common feature of the works was women’s feeling of submission and coercion in relation to health professionals who assisted them in birth.

    Figure 1 – Some results of the Gallery of Obstetric Experiences’ workshop

    Image 10000000000002CF0000021CC71389C28F96C494.jpg

    Source: photo by Catarina Barata

    12Laura is the only participant who did not use words in her piece. She drew a pregnant woman being bossed about by a giant hand in an authoritarian position of pointing a finger. Her head is bowing down in submission (figure 2). Laura said she lost control of the whole process from the moment she was made to wear a diaper – “like a baby” (como um bebé), she said – to get in the ambulance.7 She felt infantilized and powerless until she left the hospital. Her experience is a paradigmatic example of obstetric violence, with almost all the items that may correspond to the phenomenon in place, from paternalizing treatment, lack of information provision, lack of privacy (as a group of medical students was present at the delivery without requesting her permission), interventions without consent, forced immobility and verbal abuse, among others.

    Figure 2 – Laura’s diaper resulting from the Gallery of Obstetric Experiences’ workshop

    Image 100000000000033F0000022AC9568875503329CB.jpg

    Source: Photo by Catarina Barata

    13For some time, Laura believed the only way to avoid such mistreatment again would be to avoid going through labour altogether, and she wished for a caesarean section in future births. This is a common feeling among women who have experienced traumatic vaginal births, as they come to identify their negative experience with it being a vaginal birth. Upon getting pregnant for the second time, she searched for information and realized that the problem was not birth itself, but rather the obstetrical model of assistance enforced at the hospital where she had given birth. She eventually had two physiological births at home and trained as a doula.8

    14Like Laura, Rita’s strategy was to identify an overall feeling and depict it. She elected a word she felt summarizes the problem of being constantly rushed: “pressure” (pressão), and applied it with rope. About the work, she said, “I believe my diaper represents a bit of what I felt, a moment with less freedom than I would have liked, both physically and psychologically.”9 The use of rope, she shared, was “to transmit the sensation of being tied to something, because ultimately what I felt was that I was stuck to the bed, to that space.”10 She cut a hole in the fabric, which added another layer to the piece, as it allows one to see through it, at that specific point (figure 3). She explained that she felt pressure from the health personnel to hurry up, to fit a timeframe that had nothing to do with the inherent process of labour itself: “there is always pressure from the staff to hurry up, […] and it gets to a point when we are no longer ourselves, totally exhausted, and we end up giving in to all the pressure because we are also afraid and at that moment we don’t know what’s best.”11

    Figure 3 – Detail of Rita’s diaper resulting from the Gallery of Obstetric Experiences’ workshop

    Image 10000000000002DC000001E8AF48AD67F5FD3141.jpg

    Source: Photo by Catarina Barata

    15Sara drew four syringes with the word epidural surrounding a pregnant belly that reveals the baby and the placenta inside (figure 4). She wanted to symbolize the coercion she felt subjected to in order to take the epidural analgesia. Sara told us that the health professionals insisted that she take the epidural immediately, as the anaesthesiologist might not be available later on. Sara finally agreed and regrets it, for she feels that it was neither a conscious decision nor the best one. She shared, “I had already said I didn’t want it, it wasn’t what I had planned. Why so much pressure? They pressured me into following a path I didn’t want.”12 She said it was administered too early and had adverse outcomes in labour progression. This is a common complaint by women in Portugal, a country where epidural administration is generally widespread in labour management, most often regardless of the personal need or situation of the parturient in particular.13 Sara is a community nurse at the healthcare centre and added that making the diaper also made her “reflect on the pressure that we, as health professionals, exert upon our patients.”14

    Figure 4 – Sara’s diaper resulting from the Gallery of Obstetric Experiences’ workshop

    Image 100000000000039F0000026AC398722C03D38BED.jpg

    Source: Photo by Catarina Barata

    16Sara was very self-conscious about what she believed was her lack of drawing skills. When presenting her diaper, she remarked on her inability to draw and what she considered was a poor artistic result. In response, all the comments by the other participants were reassuring and complimentary, praising the expressiveness of the drawing overall and the baby inside the belly in particular, which included the detail of the placenta. The fact that she felt the need to explain with a word that the syringe referred to the epidural shows she identified a particular detail of the experience as more significant and wanted to emphasize it, in contrast to both Rita’s and Laura’s option to elect a word or concept to summarize the experience as a whole.

    17I invited Ana to participate because of her first birth experience. At 38 weeks gestation, she suffered a mechanical induction of labour without consent through membrane sweeping (commonly called toque maldoso, or “evil touch”). After long hours of labour, the birth ended up being by ventouse extraction. Ana shared with me that she feels that the only reason she had an induction was the doctor wanting to have a role in the birth. To my surprise, Ana’s diaper was based on her second childbirth instead, which she had told me had been positive overall. She tore the diaper in the centre and sewed a red towel-like cloth behind which is evocative of human tissues and blood. According to her, “red was the only colour that made sense: due to the physical issue of guts, blood and life as well as the passion with which one experiences such a moment, everything at its highest!”15 Around that, she wrote the sentence “don’t be a chicken!” (não seja piegas!) using a stencil technique (figure 5).

    Figure 5 – Ana’s diaper resulting from the Gallery of Obstetric Experiences’ workshop

    Image 100000000000033F000002058FAE7F14196C3733.jpg

    Source: Photo by Catarina Barata

    18Ana heard that sentence from an unfriendly obstetrician while she was undergoing a cervical examination. The insertion of the doctor’s fingers in her vagina was so unpleasant, that Ana contracted all of her body and groaned. The doctor seemed upset and dryly told her “don’t be a chicken!” Hearing that sentence had a negative impact on her, but she didn’t react, as she “didn’t want to start a conflict.” Ana’s professional training and experience as a fashion designer clearly facilitated her development of a more elaborate work using a fusion of techniques. Her piece might be easily interpreted as depicting a cut in the tissues, either from a caesarean section or episiotomy.16 However, Ana explained that the multiple tears in the cloth relate to the link between the exterior and interior as follows:

    “Outside, there were sentences that I didn’t want to hear, that I won’t ever forget, that weakened me and which I couldn’t react to, lying there with my vagina exposed, while everyone stood around, giving their opinion and touching it, using different methods of observation, she is a tear in me, a door to access my interior: a fluffy and textured, unknown place to me, although it is me, where my baby cosily awaits to be born.”17

    19Ana said that the main tear is a depiction of the vagina and that she chose a horizontal orientation, instead of the usual vertical representation of the vagina, because she did not want it to be obvious.

    20Mila’s proposal presented two particularities. First, while all the other works were presented in a horizontal orientation, hers was in a vertical one. Second, Mila was the only one to bring along an unfinished diaper to finish on site. This made me aware of how working on site, instead of bringing the finished work from home, would be revelatory in its own terms. I witnessed how the exchange of ideas with other participants about artistic options was productive and illuminating. Mila shared her hesitation: should she depict what marked her the most (her baby with wires attached to her head) or what she felt was the cause of the problem (the inhuman healthcare providers)? After trying both drawings on paper and hearing how the other participants found the robot-like nurse a stronger statement, more in line with the root of the problem and that better depicted the authoritative treatment she received, she eventually stuck to the original idea of the nurse (figure 6).

    Figure 6 – Mila’s diaper resulting from The Gallery of Obstetric Experiences’ workshop

    Image 10000000000001EB0000040C70025A4396D7D3D0.jpg

    Source: Photo by Catarina Barata

    21Mila is Austrian and the birth of her first child in Portugal was a long and particularly painful story to tell. She said she was subjected to many forms of abuse and felt that the fact that she was a foreigner wanting a “natural” childbirth (a birth without interventions) contributed to the discrimination. She chose to write down some of the sentences the health professionals told her during labor and post-partum that had a strong impact on her. They denote what she perceived as disrespectful care informed by prejudice, such as “You are naturalists, now you will suffer until the end” (vocês são todos naturalistas, agora vão sofrer até ao fim). As the administration of epidural analgesia is the norm in institutional birth in Portugal, those who don’t conform to the norm, i.e., those who espouse “alternative” systems can often be labelled as backward, ignorant, naive, troublemakers (Jordan apud Fedele and White 2018: 609). After a birth with complications, the baby was born needing special care and was transferred to a hospital with an appropriate NICU in a city 167 miles away. When she managed to join the baby (mothers are not necessarily transferred with newborns), and throughout the time they spent at the hospital, she told us she was prevented from being with her daughter during the night, because she asked “too many questions.” She relates she was not informed about the state of her daughter, and her suggestions about how to best care for her were dismissed by the professionals. The treatment was so rude and heartless, she said “I kept wondering: isn’t there a heart left in these people’s chest?” Sara expressed her empathy and sorrow: “Sometimes I feel ashamed to be a part of this professional class, when I hear stories like these… I find it unbelievable!” Years later, Mila decided to go to Austria for the birth of her second child in order to avoid such mistreatment. Mila’s story highlights how OV encompasses post-natal and neonatal care as well, besides prenatal care, medically assisted procreation, pregnancy and birth.

    The use of artistic expression in ethnographic inquiry – potentials and shortcomings

    22Artistic expression acted as a “field device” for experimental collaboration (Sánchez Criado and Estalella 2018) that enabled the articulation of a way of working together that facilitated reflection and discussion in novel ways. My epistemic partners used their creations as a material basis for the problematization of the research issue. Taking as a departure point the artistic creations presented, the discussion revolved around theoretical arguments about the modus operandi of the healthcare system. The participants all presented explanations for what had happened to them: the abuses they had suffered were due to the impersonal care and over-medicalization promoted at health facilities, institutions which function like factories dealing with products, rather than with people. Because of her experience in two different countries, Portugal and Austria, Mila was able to compare the approaches towards birth in the two countries. She posited that she feels that people in Portugal in general are very much “afraid of everything” and act obsessed with the idea of danger and risk.18 

    23The most common feature of the works was women’s feeling of submission and coercion in relation to health professionals who assisted them in birth. These works helped clarify what was ultimately at stake in the mistreatment as perceived by the women: being infantilized, paternalized, policed and coerced. In other words, being treated as incapable human beings and being deprived of their human characteristics. The central feature common to these women’s experiences was the lack of individualized, compassionate, respectful care. This is in line with research findings about traumatic birth experiences, where women state they felt invisible and out of control and were not treated humanely (Hogan 2008), which, in turn, shows that the most important factor in birth satisfaction is the quality of relationships/interactions with healthcare providers (Beck 2004, 2018; Elmir et al. 2010).

    24Following Chilton, Leavy enumerates the potential of an arts-based research practice: “meaning-making, empowerment, identity exploration, emotional expression, multisensory communication, consciousness-raising, healing, self-reflection and personal growth, relational connections, intersubjectivity, and expressive power” (2015: 16). These are all helpful assets for ethnographic inquiry that may be especially useful when dealing with a sensitive subject matter which may be hard to convey in words, such as subjective perceptions of experiences of violence. Leavy furthermore argues that visual images “can evoke particular kinds of emotional and visceral responses from people” (ibidem: 225). The ability to think conceptually, symbolically and metaphorically presents an interesting potential for ethnographic inquiry and one of the main advantages of art-making in a project of this nature is the concision of ideas it allows. The exercise of choosing a single word, image or concept to represent a complex and confusing experience has the effect of condensing the idea one has about it. The selection of a single most important feature also helps organize the experience and identify the underlying core issue.

    25A downside to this is that it might be somewhat reductionist. By over-simplifying a complex multifactorial experience, it can contribute to the crystallization of a perception and the objectification of the experience. By excluding many features and concentrating on a single aspect of the experience, it may leave aside aspects and contradictions that usually enrich the ethnographic description. Another shortcoming of this kind of approach is that it might fall short in providing explanations. There is a risk that the message of the work might be dubious and need a side-comment or explanation. In Ana’s work, the tears in the fabric might be very easily interpreted as a representation of a surgical cut referring to CS or episiotomy, as they resemble cut tissue, but what she actually meant to evoke was the relation between the interior (a nice thing) and exterior (unpleasant situations she had to go through). However, I must argue that the interpretation of meaning always partially depends on the receiver’s conditions and bias, even when the message seems obvious. Besides that, “the potential limitations of method can easily be turned around to become strengths”, as Banks puts it (2007: 120). Following Banks, I argue that the capacity of a work to allow a multiplicity of interpretations should be considered a plus. Reality is never univocal and the arts have a strong evocative power that can be used to process ambiguity and multivocality. The constitution of a material object that works as a vehicle of expression counterbalances the uncertainty of interpretation and the shortcomings of this arts-based approach.

    26All participants affirmed that they found the creative process very productive. Although they commented that making the diaper made them relive the experience of birth and that it had been painful, they also said it helped them “digest something that hurt and disappointed” them during childbirth, allowed them to find yet another way of expressing a very painful feeling that had long-lasting effects and contributed to “coming to terms with the trauma.” My perception throughout several years of fieldwork about birth is that too many women have to deal with traumatic birth experiences in silence. Although birth experiences are utterly striking events, the social dynamics of our society do not allow spaces to overtly discuss them. Sexual and physiological experiences, including childbirth, are considered private matters and are kept away from the public arena, with the consequence of establishing a silence regarding these issues. Traumatic experiences of obstetric violence often provoke a sense of incapacity to process and express them, while at the same time it is usually through expression and sharing with others that victims are able to overcome trauma. Sharing of experiences with other women proves to be of fundamental importance in order for women to process them (Hogan 2015, 2018). Most workshop participants, like many women I have interviewed, recount they felt guilty about their traumatic birth stories for a long time. They thought it was ultimately their fault that birth did not unfold in the best way, a consequence of their personal incapacity with regards to birth. Only when they came across other women’s birth stories (often through Internet groups and forums about motherhood), did they realize it was a widespread phenomenon with a structural dimension, hence not their own personal fault. The creation of spaces where people can share their experiences in a supporting environment is of paramount importance. The constitution of artworks is a useful and effective device in the efforts of visibilization through the materialization of perceptions. It was agreed with the participants that I would keep the results of the workshop and use them in public settings to raise awareness about OV. Sara said that she hoped this would make health professionals reflect on the subject, changing their minds and everyday practices.

    27As with focus groups, I felt the number of participants of such sessions must be limited, to allow proximity and the time to share. I also had a hint of how continuous work with the same group would allow a deeper understanding, by building confidence between participants and deepening both the discussion and the means of creation. However, I must acknowledge the difficulty of recruiting a group committed to continuous work, which would require an amount of time that mothers commonly feel they do not have. 

    Conclusion

    28The pieces created revealed that paternalizing treatment and coercion by health professionals were the core aspects of perceptions of traumatic birth experiences of OV. Women employed a variety of techniques and used different approaches to convey their ideas, from identifying a particular detail of the experience to finding a general concept to depict the experience as a whole. What all the works had in common was the reference to different kinds of authoritarian behaviour by health personnel, from not attending to women’s needs and preferences to coercing into unnecessary interventions. The most striking common feature of women’s negative experiences was the feeling of submission imposed by those who attended them during birth. Women expressed they did not feel heard or cared for, and felt devoid of their basic human characteristics. They attributed the lack of “humane” care to the depersonalization and over-medicalization promoted at health facilities. 

    29Art is a powerful communication tool, and a fertile departure point for debate. The pieces created so far materialized experiences of obstetric violence that until then only existed in people’s memories, imaginations and sense of being. These pieces “device the field” (Sánchez Criado and Estalella 2018) by causing a real impact on the subject matter. Their existence and what they represent becomes constitutive of the fieldwork: they affect it through the materialization of ideas about subjective experiences, the imaginary and semantic implications they help to build, and the public exposure to feed a political debate. These pieces thus allow a visibilization of a subject matter that serve as a material basis for the discussion and conceptualization. Besides art’s transformational quality, which is related to a somewhat therapeutic effect (Hogan 2015, 2018), the major outcome of the creative endeavour was its capacity to help each participant organize an experience that was complex and disorientating. By presenting a condensed depiction of the experience, based on personal choices of what to include and what to exclude, the revelations of these works help us understand what is at the core of perceptions regarding OV experiences. The exercise of conceptual clarification at play when creating an artwork contributed to the identification of the underlying issue at stake for the participants. All participants underlined that using art to express their birth experiences had a very positive effect on them, although there was some pain involved, as they relived the experience while making the pieces. By condensing a complex experience constituted by many aspects in a single depiction, the participant is made to reflect on what was the most striking feature in the whole experience, and more easily comes to understand what is ultimately at stake. 

    30There is a risk that the result is an over-simplification of the perception and that it underrepresents the multiplicity of the experience. It may require a side-comment or explanation if the author wants to maintain control over the piece’s reception. Another important shortcoming to consider is the fact that lack of formal education in art making may deter people from experimenting with tools they do not master. Nevertheless, the capacity of an object to open up a multiplicity of interpretations may also be considered an advantage. Its ability to raise multiple sensations and evoke multiple meanings may instead contribute to an enrichment of the field. Given the clear benefits the results have shown, experimental collaboration should be fostered in an inclusive environment. Creative expression has the ability to communicate on a level that easily provokes empathy among receptors, and these shortcomings are counter-balanced by the communicative impact of the pieces. Further research on the reception of these works by health professionals and society at large will help assess the capacity of creative expression as a facilitator of communication and understanding between groups. The way artworks can contribute to the exposure of negative birth stories on the public scene, capitalizing personal experiences for political goals through activist action, will be the subject of future analysis. This approach offers important avenues of research on birth and other issues related to body and gender in illuminating perceptions of subjective experiences that social scientists and health professionals alike can benefit from.

    Acknowledgements

    31I am indebted to Amanda Guerreiro, Anna Fedele, Chiara Pussetti, Francesco Vacchiano, Maria Concetta lo Bosco, João Baptista and João Pina-Cabral for their comments on this chapter.

    32This work is based on research funded by FCT/MCTES, the Portuguese Foundation for Science and Technology of the Ministry of Science, Technology and Higher Education, and the ESF, the European Social Fund, as part of my activities as a Ph.D. candidate (SFRH/BD/128600/2017) at the Institute of Social Sciences of the University of Lisbon (ICS-ULisboa), Portugal.

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    Banks, Marcus. Using Visual Data in Qualitative Research. [], SAGE Publications Ltd, 2018. Crossref, https://doi.org/10.4135/9781526445933.
    Beck, Cheryl Tatano. “Birth Trauma”. Nursing Research, vol. 53, no. 1, Ovid Technologies (Wolters Kluwer Health), Jan. 2004, pp. 28-35. Crossref, https://doi.org/10.1097/00006199-200401000-00005.
    Beck, Cheryl Tatano. “A Secondary Analysis of Mistreatment of Women During Childbirth in Health Care Facilities”. Journal of Obstetric, Gynecologic &Amp; Neonatal Nursing, vol. 47, no. 1, Elsevier BV, Jan. 2018, pp. 94-104. Crossref, https://doi.org/10.1016/j.jogn.2016.08.015.
    Bohren, Meghan A., et al. “The Mistreatment of Women During Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review”. PLOS Medicine, edited by Rachel Jewkes, vol. 12, no. 6, Public Library of Science (PLoS), 30 June 2015, p. e1001847. Crossref, https://doi.org/10.1371/journal.pmed.1001847.
    Elmir, Rakime, et al. “Women’s Perceptions and Experiences of a Traumatic Birth: A Meta-Ethnography”. Journal of Advanced Nursing, vol. 66, no. 10, Wiley, 16 July 2010, pp. 2142-53. Crossref, https://doi.org/10.1111/j.1365-2648.2010.05391.x.
    Fedele, Anna, and Joanna White. “Birthing Matters in Portugal: Introduction”. Etnografica, no. vol. 22 (3), OpenEdition, 1 Oct. 2018, pp. 607-18. Crossref, https://doi.org/10.4000/etnografica.5951.
    Hale, Frank W., and William E. Kirwan. What Makes Racial Diversity Work in Higher Education. [], Routledge, 2023. Crossref, https://doi.org/10.4324/9781003448662.
    Hogan, Susan. “Mothers Make Art: Using Participatory Art to Explore the Transition to Motherhood”. Journal of Applied Arts &Amp; Health, vol. 6, no. 1, Intellect, 1 June 2015, pp. 23-32. Crossref, https://doi.org/10.1386/jaah.6.1.23_1.
    Hogan, Susan. Arts Therapies and Gender Issues. [], Edited by Susan Hogan, Routledge, 30 July 2019. Crossref, https://doi.org/10.4324/9781351121958.
    Hogan, Susan, and Sarah Pink. “Routes to Interiorities: Art Therapy and Knowing in Anthropology”. Visual Anthropology, vol. 23, no. 2, Informa UK Limited, 4 Feb. 2010, pp. 158-74. Crossref, https://doi.org/10.1080/08949460903475625.
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    Notes de bas de page

    1 Galeria das Experiências Obstétricas: https://galeriadasexperienciasobstetricas.wordpress.com/.

    2 https://www.youtube.com/watch?v=NcHdF1eHhgc.

    3 Trauma is a deeply distressing or disturbing experience, which may have long-term negative consequences.

    4 “Gynaecological and obstetric violence” are sometimes referred to in tandem as a unified concept, e.g., Resolution 2306 (2019) of the Council of Europe “Obstetrical and gynaecological violence”: http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-EN.asp?fileid=28236&lang=en&fbclid=IwAR1Fs_3dBoi-tKCM7djPEsTgGik2ZWjLbuBM4yDJfDPvo2FX5imvAE6xSow.

    5 Monty Python, 1983, “The Miracle of Birth”, in The Meaning of Life, feature film, 107 mins. https://www.youtube.com/watch?v=NcHdF1eHhgc.

    6 The practice of pressing on the uterine fundus to facilitate a vaginal delivery, which is recognised as a dangerous manoeuvre that carries the risk of uterine rupture and may even have rib breaking as collateral damage. Women usually describe it as causing unbearable pain and depriving them of the capacity to breathe. Although the medical literature recommends against it, it is a common procedure in Portugal and elsewhere (APDMGP 2015; Rohde 2016).

    7 The hospital is a one-hour drive from the village, women may either drive there in a private car or call an ambulance. Laura went to the emergency service at the healthcare centre first and was then transferred to the hospital by ambulance.

    8 A doula is a person who provides emotional support to a woman during pregnancy, birth and post-partum. S/he does not practice medical acts.

    9 “[…] creio que a minha fraldinha representa um pouco do que senti, um momento com menos liberdade do que gostaria, tanto física quanto psicológica.”

    10 “[…] para transmitir a sensação de estar preso a algo, porque no fundo o que senti foi que estava presa à cama, àquele espaço […].”

    11 “[…] havia sempre a pressão da equipa querer despachar, […] e chega a um ponto, quando já nem estamos em nós pelo cansaço, que acabamos por ceder a toda a pressão, porque também temos medos e naquele momento já não sabemos o que é melhor […].”

    12 “Já tinha dito que não queria, não estava nos meus planos. Porquê tanta pressão? Pressionaram-me a ir por um caminho que não queria.”

    13 Despite this, there are also complaints by women who felt ignored by staff when they asked for analgesia, which may also constitute OV.

    14 “Fez-me refletir também acerca da pressão que nós, profissionais de saúde, exercemos sobre os nossos utentes.”

    15 “O vermelho foi a única cor que fez sentido: pela questão física das entranhas, sangue, vida e também pela paixão com que se vive um momento destes, tudo ao rubro!”

    16 An incision in the perineum. Although the scientific literature recommends against its routine use, the rate in Portugal (73%) shows it is a common procedure (APDMGP 2015; Euro-Peristat 2010; Rohde 2016).

    17 “Cá fora houve frases que não queria ouvir, que não vou esquecer, que me fragilizam e às quais não consegui reagir, sempre com a vagina exposta, para onde todos olham e opinam e tocam e usam métodos vários de observação, ela é um rasgo em mim, porta de acesso para o meu interior: sítio fofo e texturado, desconhecido para mim embora seja eu própria, onde o meu bebé aconchegado espera por nascer.”

    18 It is interesting to note that the intervention rates in Austria are overall lower than in Portugal, such as CS rates (in Austria at 28.8%, while in Portugal at 36.3%) and vaginal instrumental (in Austria at 5.6% and in Portugal at 14.9%), according to Euro-Peristat (2010). Although interventions in themselves do not equate to OV, high intervention rates are considered indicative of poor quality obstetric care.

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    1 Galeria das Experiências Obstétricas: https://galeriadasexperienciasobstetricas.wordpress.com/.

    2 https://www.youtube.com/watch?v=NcHdF1eHhgc.

    3 Trauma is a deeply distressing or disturbing experience, which may have long-term negative consequences.

    4 “Gynaecological and obstetric violence” are sometimes referred to in tandem as a unified concept, e.g., Resolution 2306 (2019) of the Council of Europe “Obstetrical and gynaecological violence”: http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-EN.asp?fileid=28236&lang=en&fbclid=IwAR1Fs_3dBoi-tKCM7djPEsTgGik2ZWjLbuBM4yDJfDPvo2FX5imvAE6xSow.

    5 Monty Python, 1983, “The Miracle of Birth”, in The Meaning of Life, feature film, 107 mins. https://www.youtube.com/watch?v=NcHdF1eHhgc.

    6 The practice of pressing on the uterine fundus to facilitate a vaginal delivery, which is recognised as a dangerous manoeuvre that carries the risk of uterine rupture and may even have rib breaking as collateral damage. Women usually describe it as causing unbearable pain and depriving them of the capacity to breathe. Although the medical literature recommends against it, it is a common procedure in Portugal and elsewhere (APDMGP 2015; Rohde 2016).

    7 The hospital is a one-hour drive from the village, women may either drive there in a private car or call an ambulance. Laura went to the emergency service at the healthcare centre first and was then transferred to the hospital by ambulance.

    8 A doula is a person who provides emotional support to a woman during pregnancy, birth and post-partum. S/he does not practice medical acts.

    9 “[…] creio que a minha fraldinha representa um pouco do que senti, um momento com menos liberdade do que gostaria, tanto física quanto psicológica.”

    10 “[…] para transmitir a sensação de estar preso a algo, porque no fundo o que senti foi que estava presa à cama, àquele espaço […].”

    11 “[…] havia sempre a pressão da equipa querer despachar, […] e chega a um ponto, quando já nem estamos em nós pelo cansaço, que acabamos por ceder a toda a pressão, porque também temos medos e naquele momento já não sabemos o que é melhor […].”

    12 “Já tinha dito que não queria, não estava nos meus planos. Porquê tanta pressão? Pressionaram-me a ir por um caminho que não queria.”

    13 Despite this, there are also complaints by women who felt ignored by staff when they asked for analgesia, which may also constitute OV.

    14 “Fez-me refletir também acerca da pressão que nós, profissionais de saúde, exercemos sobre os nossos utentes.”

    15 “O vermelho foi a única cor que fez sentido: pela questão física das entranhas, sangue, vida e também pela paixão com que se vive um momento destes, tudo ao rubro!”

    16 An incision in the perineum. Although the scientific literature recommends against its routine use, the rate in Portugal (73%) shows it is a common procedure (APDMGP 2015; Euro-Peristat 2010; Rohde 2016).

    17 “Cá fora houve frases que não queria ouvir, que não vou esquecer, que me fragilizam e às quais não consegui reagir, sempre com a vagina exposta, para onde todos olham e opinam e tocam e usam métodos vários de observação, ela é um rasgo em mim, porta de acesso para o meu interior: sítio fofo e texturado, desconhecido para mim embora seja eu própria, onde o meu bebé aconchegado espera por nascer.”

    18 It is interesting to note that the intervention rates in Austria are overall lower than in Portugal, such as CS rates (in Austria at 28.8%, while in Portugal at 36.3%) and vaginal instrumental (in Austria at 5.6% and in Portugal at 14.9%), according to Euro-Peristat (2010). Although interventions in themselves do not equate to OV, high intervention rates are considered indicative of poor quality obstetric care.

    Modos de Fazer, Modos de Ser

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    Référence numérique du chapitre

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    Barata, C. (2022). The Gallery of Obstetric Experiences: addressing perceptions of obstetric violence through ethnography-based artistic experimentation. In T. Fradique & R. Lacerda (éds.), Modos de Fazer, Modos de Ser (1‑). Etnográfica Press. https://doi.org/10.4000/books.etnograficapress.8122
    Barata, Catarina. « The Gallery of Obstetric Experiences: Addressing Perceptions of Obstetric Violence through Ethnography-Based Artistic Experimentation ». In Modos De Fazer, Modos De Ser, édité par Teresa Fradique et Rodrigo Lacerda. Lisboa: Etnográfica Press, 2022. https://doi.org/10.4000/books.etnograficapress.8122.
    Barata, Catarina. « The Gallery of Obstetric Experiences: Addressing Perceptions of Obstetric Violence through Ethnography-Based Artistic Experimentation ». Modos De Fazer, Modos De Ser, édité par Teresa Fradique et Rodrigo Lacerda, Etnográfica Press, 2022, https://doi.org/10.4000/books.etnograficapress.8122.

    Référence numérique du livre

    Format

    Fradique, T., & Lacerda, R. (éds.). (2022). Modos de Fazer, Modos de Ser (1‑). Etnográfica Press. https://doi.org/10.4000/books.etnograficapress.8044
    Fradique, Teresa, et Rodrigo Lacerda, éd. Modos de Fazer, Modos de Ser. Lisboa: Etnográfica Press, 2022. https://doi.org/10.4000/books.etnograficapress.8044.
    Fradique, Teresa, et Rodrigo Lacerda, éditeurs. Modos de Fazer, Modos de Ser. Etnográfica Press, 2022, https://doi.org/10.4000/books.etnograficapress.8044.
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