April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: “I delivered with a team where I recognized no one”: Understanding Depersonalization of Healthcare Through Women’s Birth Stories
BACKGROUND: COVID-19 accelerated depersonalized healthcare, particularly in hospitals, which raises a myriad of ethical and human rights concerns (Arnold & Kerridge, 2020). This is particularly true in obstetrics, where the pandemic reduced interpersonal interactions and increased medical interventions (Rice & Williams, 2022). Coinciding with these disruptions, individuals who gave birth experienced a higher risk for reduced access to in-person care, stillbirths, anxiety, and depression (Chmielewska et al., 2021). Women’s birth stories reveal the fundamentally dialogical nature of birth and how rules restricting the presence of complementary healthcare providers and support persons reshaped how women understood their experiences (Scott et al., 2022). Women’s narratives also reveal how they interpret the dialogical and relational setting of the hospital experience itself (Scott et al., 2009). In the present work, we call upon Buber’s philosophical work (1958) by exploring relationships in health settings to understand how women’s birth narratives reveal their relative orientation to their healthcare providers and obstetric procedures during the pandemic.
METHOD: We analyzed data collected as part of a larger COVID-19 birth story project that included elicited birth stories from focus groups, written accounts, and a follow-up interview at about 1 year postpartum (n=50) to explore patterns in how women described their orientation to their healthcare providers and procedures during their birth experiences. Participants were from 19 states and had given birth between March and July 2020. The majority of participants (n=40, 80%) identified as White, and 8% (n=4) identified as Hispanic or Latina. We analyzed the data using a phronetic iterative approach, which is inquiry guided by coding in cycles and memo-writing (Tracy, 2020).
FINDINGS: Our overarching finding is that women’s narratives reveal a perceived depersonalization with their healthcare providers. Women used passive language about healthcare providers who largely remained nameless and faceless in their narratives. Commonly used phrases included, “We were told,” “The hospital told us,” “The office told us,” and “They” as the primary descriptor of healthcare providers. Within this overarching theme of depersonalized healthcare, two primary metaphors emerged including being a part of a machine and being in a ghost town. The mechanistic nature of women’s experiences manifested as a lack of autonomy revealed through their narratives. One participant shared, “We went to the hospital masked up and ready to be faced with stringent terms and conditions.” Stories also included descriptions of the hospital as a cold, lifeless place, forming the ghost town metaphor. One woman shared, “It was just so empty and vacant, even I got up to try and walk when I was maybe five centimeters, and I saw nothing. Like no one.”
CONCLUSIONS: COVID-19 stripped bare the underlying fault lines in our healthcare system, notably revealing the depersonalization in birth narratives that dominates the increasingly transactional nature of medicine. These stories help to uncover the patterns in how women view the relational and dialogical nature of their experiences and demonstrate how far we have to go in achieving relationship-centered healthcare.
METHOD: We analyzed data collected as part of a larger COVID-19 birth story project that included elicited birth stories from focus groups, written accounts, and a follow-up interview at about 1 year postpartum (n=50) to explore patterns in how women described their orientation to their healthcare providers and procedures during their birth experiences. Participants were from 19 states and had given birth between March and July 2020. The majority of participants (n=40, 80%) identified as White, and 8% (n=4) identified as Hispanic or Latina. We analyzed the data using a phronetic iterative approach, which is inquiry guided by coding in cycles and memo-writing (Tracy, 2020).
FINDINGS: Our overarching finding is that women’s narratives reveal a perceived depersonalization with their healthcare providers. Women used passive language about healthcare providers who largely remained nameless and faceless in their narratives. Commonly used phrases included, “We were told,” “The hospital told us,” “The office told us,” and “They” as the primary descriptor of healthcare providers. Within this overarching theme of depersonalized healthcare, two primary metaphors emerged including being a part of a machine and being in a ghost town. The mechanistic nature of women’s experiences manifested as a lack of autonomy revealed through their narratives. One participant shared, “We went to the hospital masked up and ready to be faced with stringent terms and conditions.” Stories also included descriptions of the hospital as a cold, lifeless place, forming the ghost town metaphor. One woman shared, “It was just so empty and vacant, even I got up to try and walk when I was maybe five centimeters, and I saw nothing. Like no one.”
CONCLUSIONS: COVID-19 stripped bare the underlying fault lines in our healthcare system, notably revealing the depersonalization in birth narratives that dominates the increasingly transactional nature of medicine. These stories help to uncover the patterns in how women view the relational and dialogical nature of their experiences and demonstrate how far we have to go in achieving relationship-centered healthcare.