RESULTADO 1

The methodology for this research was informed by my conceptual framework and by the preceding review of the literature. I chose to use a feminist narrative approach to inquiry and analysis as this approach privileges subjugated knowledges and allows for an exploration of how discourse shapes understanding and experiences. In this

privileging, knowledge is created that highlights the lived experiences and social conditions associated with marginalization, challenges dominant stories, and creates a focus for social change (Clandinin, 2013; Frank, 2005). By focusing on experience, a feminist narrative approach rejects the ideas of a single truth, and instead seeks deeper meaning through both commonalties well as particularities of experience. Through centring the emotion of distress, my feminist narrative inquiry and analysis allowed for a challenge to dominant ideas regarding emotional pain and in doing so politicized the concept of trauma. And finally, as a feminist approach, my research considered gender and its intersections with other social markers and material realities in my exploration of childbirth.

The Purpose

This research study had two purposes. First, this study explored experiences of distress in childbirth from a perspective which allowed hidden, taken-for-grated ideas about childbirth distress to be illuminated. Thus, dominance was disrupted and

subordinate and subjugated knowledges about childbirth were made visible. Secondly, my goal in undertaking this research as a social work researcher, and as a social work

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praxis. I believe social work has an opportunity to improve services to those living with and through distressing childbirth experiences. I also believe in order to do this, social work needs its own research and insights into these experiences and the needs of those with whom we might potentially work.

Qualitative approaches are best suited to this type of research, as they allow deeper understandings of the complexity of lived experiences in a way that quantitative approaches cannot (Polkinghorne, 2005). Qualitative inquiry applies especially when “research topics … appear to defy simple quantification [as] the qualitative researcher may recognize several nuances of attitude and behavior that might escape researchers using other methods” (Rubin & Babbie, 2011, p. 435) and qualitative methods allow information to emerge that the interviewer may not have thought of when designing a research question (Allsop, 2013). Qualitative research design has flexibility as an asset, being more amenable to modification even once the project has started (Allsop, 2013; Rubin & Babbie, 2011). In a qualitative study the researcher takes the position of assuming the need to develop deeper understandings of the phenomenon and “its subjective meanings as it occurs in its natural environment” (Rubin & Babbie, 2011, p.183). By developing these deeper understandings, the researcher seeks to uncover themes and patterns from more unstructured observations and interactions (Allsop, 2013; Polkinghorne, 2005; Rubin & Babbie, 2011). Thus, a qualitative research design was the best fit to uncover what is missing from understandings of experiences of distress

associated with childbirth, on a very specific, albeit non-generalizable level.

This research study asked the question “What are individuals’ experiences of distress in childbirth” in order to increase understanding about these experiences and to

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explore how these experiences were both discursively constructed and discursively constrained. While the findings from this qualitative study were not intended to be generalizable, they provide important insights, and they act as a launching off point for further study; once themes and/or new insights are identified they can be used to create questions for further investigation. The strength of this feminist narrative qualitative study was its ability to gather a depth of information with many specific details and meanings. These meanings contributed to new understandings of the everyday occurrence of childbirth.

Research Design

A feminist narrative inquiry and analysis is a qualitative research approach that was best suited to address the research question. Furthermore, a feminist narrative inquiry and analysis exploring experiences of distress in childbirth fit with the conceptual

framework outlined earlier. This methodology allowed a consideration of how

participants constructed their identities through self-narratives, in a manner reflecting an orientation towards maintaining a “coherent sense of identity across different contexts and accounts” (Stapleton & Wilson, 2004) and in doing so provided opportunity to

highlight discursive reproductions of dominance. Thus an analysis of childbirth narratives allowed for an examination of how constructs related to distress, and to the narrators’ identities (such as gender, class, race, and sexuality), came to be constituted though childbirth and also how they constituted childbirth experience and discourse. That is, childbirth narratives provided a site of analysis of both meaning and discourse. In doing so, the feminist narrative inquiry and analysis I undertook, paid attention to the both the material and discursive understandings of the body. It allowed for a disruption of binary

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oppositions that reflected dominant ideas of race, class, and gender, while at the same time reflecting a recognition of the importance of maintaining class, race, gender, and other social locations within the scope of the analysis (Pamphilon, 1999; Warhol, 2012).

Feminist narrative inquiry and analysis enables the co-constructions of

knowledges as the researcher moves between data collection and analysis (Brown Wilson, 2009). Researchers using feminist narrative inquiry and analysis as a methodology, seek to change power relationships, reject ideas of neutrality and objectivity, and incorporate reflexivity (Morris, 2005). For my research, feminist narrative methodology made space for people’s voices to be heard and allowed for connections between these voices in a way that may illuminate and challenge existing dominant narratives around childbirth.

A concern with approaches centring experiences and looking to marginalized voices for truth is they recreate the very search for a truth emblematic of positivism. Scott (1991) explains:

When experience is taken as the origin of knowledge, the vision of the individual subject (the person who had the experience or the historian who recounts it) becomes the bedrock of evidence on which explanation is built. Questions about the constructed nature of experience, and how subjects are constituted as different in the first place, about how one’s vision is structured—about language (or

discourse) and history—are left aside. (p. 777)

Experience has no special epistemic privilege. Because experience is interpreted through a filter of thought and understanding which is influenced by (if not bounded by) the world in which one lives, experienced-based knowledge is likely to (at least partially) represent dominant knowledge (Berger & Luckmann, 1967; Brown, 2012; Fegan, 2012;

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Polkinghorne, 2005; Scott, 1991; Stone-Mediatore, 2003). And while I believe in the critical political power of experienced-based knowledge, I also agree this knowledge may reflect dominant discourse. The approach that I have used addressed this concern with balancing the importance of experience as an underappreciated site of interest, while recognizing the limits of experienced-based knowledge. Here, narratives were analyzed for subjugated knowledge as well as for reflections of dominant narratives, with an interest in how participants navigated these realities (Stone-Mediatore, 2003). However, feminist narrative inquiry and analysis necessarily only highlights the subjugated

knowledges it seeks out. The researcher can only highlight the voices of those who participate, and these may or may not represent various sites of privilege and

marginalization. A general weakness of narrative research approaches is that narratives are a reflection on and retelling of the past and they speak to dominant structures, rather than calling for their dismantling. However, the feminist approach to narrative I used took up the interaction of analysis of the themes and structures, and served as a tool to

highlight power structures that constrain and define narratives. In this way, narratives could be taken up to assist with dismantling oppressive discourses and institutions as the information gained can be used to create new awareness of knowledges resulting in social change (Frank, 2008).

The Creation of Feminist Research and Narrative Analysis

Knowledge production, dissemination, and meaning making through storytelling have been with us as long as stories have existed. While narrative is linked to the oral tradition within the Indigenous viewpoint through storytelling, oral history, and storywork, as important means of connections across history, time, and people

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(Archibald, 2008; Moreton-Robinson, 2000; Native Women’s Association of Canada [NWAC], 2013; Struthers & Peden-McAlpine, 2005); academic interest in narratives began only as recently as the 1960s (Davis, 2002; Holstein & Gubrium, 2011; Riessman & Quinney, 2005; C. P. Smith, 2000; Squire et al., 2013). The various rights movements of the 1960s and 1970s influenced the academic interest in narratives through their rejection of dominant stories standing as normative, and insistence on the voices of the marginalized being heard (Davis, 2002; Holstein & Gubrium, 2011; Riessman & Quinney, 2005; C. P. Smith, 2000; Squire et al., 2013).

Feminist research. Feminist research methodologies began as a challenge to androcentric bias in research, reflecting the belief that women’s experiences had not been omitted by oversight but instead had been “suppressed, trivialized, ignored, or reduced to the status of gossip and folk wisdom by dominant research traditions institutionalized in academic settings and scientific disciplines” (K. Anderson, Armitage, Jack, & Wittner, 2004; Hesse-Biber, 2008). Feminist researchers of various branches within feminism began to write about how their own stories intersected with those of their participants and viewed narrative as more than a way to exchange information (Kimpson, 2005; Padgett, 2008). They were also interested in the idea of research participants as active agents in the narrative and research process, exploring subjective meanings and experiences that had been ignored or silenced in previous research, allowing for new insights and awareness into social processes (Holstein & Gubrium, 2011; Pinnegar & Daynes, 2007; Riessman, 2013). Thus, the focus and goal of some feminist narrative analysis is to examine current theories and develop new theory about subjugated knowledges that more fully reflect marginalized lives (Chase, 2005; Kimpson, 2005).

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Narrative analysis. Narrative analysis can take many forms. The focus of narrative analysis may be on themes, structures, function, on the interplay between the story and the storytelling, and may focus on a single event, an entire life, or an experience (Chase, 2005; Holstein & Gubrium, 2011; Riessman, 2013; Squire et al., 2013).14

Narrative analysis can be divided into two analytic categories; those that analyze the themes of narratives, and those that analyze the structures of narratives (Holstein & Gubrium, 2011; Riessman, 2008; Squire et al., 2013). Thematic narrative analyses focus on the storied content of personal narratives with plots and themes as the focus of analysis, whereas structural approaches to narrative analysis, focus on the practice and structure of narrative, often making use of discourse and conversation analysis (Holstein & Gubrium, 2011). It is also possible to combine the two approaches. In the combined approach, the researcher selects aspects of each form of analysis resulting in a

thematic/structural narrative analysis (Holstein & Gubrium, 2011). Here the researcher “focuses on the way storytelling operates in and relation to its social environment” (Holstein & Gubrium, 2011, p. 8). The emphasis is on the interaction of the themes and structures and includes an analysis of how relations of power shape narratives (Andrews, 2013; Holstein & Gubrium, 2011). The thematic/structural approach includes an analysis of narrative resources—that is, what is available to be said as determined through

14 _{In addition to feminist narrative analysis, there are a wide variety of other forms of} narrative analysis. Various approaches focus on different aspects of the narrative and are associated with various disciplines and influences (Chase, 2005). These disciplines and influences include literary criticism, history, psychology, sociology, anthropology, sociolinguistics, philosophy, education, nursing, legal studies, and occupational therapy, (Chase, 2005; Creswell, Hanson, Plano, & Morales, 2007; Davis, 2002; Polkinghorne, 2007; Riessman, 2013; Riessman & Quinney, 2005).

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institutions of power (Frank, 2008; Holstein & Gubrium, 2011; Pamphilon, 1999). Feminist narrative inquiry and analysis. A feminist narrative approach that combines a thematic and structural analysis is consistent with the epistemological stance that underlies this research and thus was used in this study of the discursive construction of experiences of distress in childbirth. This approach involves an iterative and shared understanding that is contextualized, considers power in relation to knowledge and discourse reflected in narratives, and privileges subjugated knowledges. This approach to feminist narrative analysis is undertaken in multiple and interactive phases. In feminist narrative methodology, the process of data collection, interpretation, and analysis are not divided into concrete stages, but instead these occur in an iterative manner throughout the research process (Brown Wilson, 2009; Hydén, 2013). Thus when defining the

methodology I use the term “narrative inquiry and analysis” in an effort to reflect my understanding of, and commitment to, narrative as a method as well as an outcome, rather than viewing narrative as something static, and as a product for consumption through analysis (Georgakopoulou, 2006).

Trustworthiness in Feminist Narrative Inquiry and Analysis

As there are many varieties of narrative research, there is no consensus among narrative researchers regarding which criteria is best to evaluate the rigour of the design. (Clandinin & Connelly, 2000; Connelly & Clandinin, 1990; Polkinghorne, 2007;

Riessman, 2002, 2013). I have chosen to engage with the work of Lincoln and Guba (1985) and Creswell and Poth (2017). Lincoln and Guba introduced the idea of

trustworthiness as the central concept for research evaluation and even though the concept of trustworthiness is no longer new, their criteria for evaluation are well established and

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remain popular in qualitative research (Creswell & Poth, 2017). While the evaluation criteria they proposed are not specific to narrative research, they can apply to narrative research. More recently, Creswell and Poth (2017) have proposed a comprehensive method for evaluating qualitative research using the “lens strategy” (p. 259) wherein the research is evaluated through the researcher’s lens, the participant’s lens, and the reader’s lens. Thus, the trustworthiness of this proposed research is assessed through a

consideration of the credibility, transferability, confirmability, and dependability of my processes and findings (Lincoln & Guba, 1985) and the criteria for assessing these criteria makes use of the various lenses proposed by Creswell and Poth (2017).

Credibility

Credibility is the degree of fit between the respondents’ views and the researcher’s description and interpretations of these views (Creswell & Miller, 2000; Lincoln & Guba, 1985; Padgett, 2008). When using a feminist narrative approach to data analysis, my own story no doubt informed my analysis. While a narrative strategy aims to centre and privilege the participants’ experience, I interpreted the data and determined which narratives represented the findings of the research (Borland, 2004; Clandinin & Caine, 2013; Cooper & Burnett, 2006; Ellis & Berger, 2002; Frank, 2005; Kimpson, 2005; Pamphilon, 1999; Polkinghorne, 2007). Riessman (2002) explains that the particular narratives and themes that a researcher chooses to write about are linked to the evolving research question, the theoretical frameworks taken up by the researcher, the researcher’s values and beliefs, and the researcher’s own life history. In considering this risk to credibility, Creswell and Poth (2017) propose as part of the researcher’s lens, that the researcher commit to a process of reflexivity, wherein the researcher discloses her

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“biases, values, and experiences” (p. 261). In this research I strived to make myself evident in the work, both in my writing and in my interviews with participants. For example, disclosing some of my own history with participants as appropriate and explaining to the participants and to the reader/reviewer why I was asking specific follow-up questions.

Referring to the participant’s lens, Creswell and Poth (2017) also recommend member checking as a means towards minimizing threats to credibility. Use of member checking is an important aspect to credibility, allowing the participants to respond to what the researcher has written, and provide changes, correction, and additions that contribute to a rich description that reflects what the participants want to say (Lincoln & Guba, 1985). In this research, member checking was used in the transcription and interpretation stages when participants were offered the opportunity to review and provide feedback up to the level of the individual narratives. The point of this proposed research was not to find a single truth (either mine or the participants’), but to gain insight into participants’ experiences and how those experiences are constructed. Researcher and participant agreement was not necessary, and this was discussed with participants as part of their ongoing consent (Clandinin & Connelly, 2000; Padgett, 2008). In addition to member checking, prolonged engagement with participants also helped to address any credibility threats (Creswell & Poth, 2017). I spent time with the participants in their homes playing with their children; I attended playgroups and drop-ins; and I got to know many of the participants beyond the time we spent together in the interviews.

A threat to credibility in this proposed research was the risk of seeking and re- inscribing essentialist female identity and experiences of childbirth by assuming

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commonality of experience despite a lack of racial and other sites of diversity in the participants. I have attempted to mitigate this risk by being clear that a lack of diversity is a limitation of this study. Credibility may also have been challenged if any of my own essentialist notions of women and childbirth (of which I may not have been aware) were woven into the research, preventing me from asking certain questions, hearing certain information, and causing me to miss out on potential meanings and connections in my analysis. Through debriefing with other researchers, journaling, and consultation with mentors, I worked to avoid making assumptions that might have been associated with associated essentialist notions (Creswell & Miller, 2000; Cresswell & Poth, 2017; Lincoln & Guba, 1985).

An idea associated with credibility is truthfulness. Narrative analysis assumes it is possible for multiple points of view to be ‘truthful’, and as such is not intended to

represent a single ahistorical truth. Therefore the normative question of the truthfulness, as a single possibility, is not pursued in narrative analysis. Instead the focus is on how the narrative is helpful in producing insights from narratives that others might relate to (Barbour, 2008; Clandinin & Connelly, 2000; Franzosi, 1998; Kong, Mahoney, & Plummer, 2003; Parton & O’Byrne, 2000; Polkinghorne, 2007; Riessman, 2002). Riessman (2013) explains:

Verification of the ‘facts’ of lives is less salient than understanding the changing meanings of events for the individuals involved, and how these, in turn, are located in history and culture. (p. 182)

If a participant told a story that differed from another’s version there was still useful information to be had. As the researcher I considered how the participant came to tell the

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story this way; what information was added, left out, or changed; and what this represented in terms of meaning making and understandings (Brown, 2012). Indeed, stories that varied greatly from each other were also an important aspect of credibility (Creswell & Poth, 2017). Using the researcher’s lens, Creswell and Poth (2017) explain that negative case analysis involves identifying stories and themes that conflict with the main findings, recognizing that not all data will fit neatly into specific codes or themes. For example, in this study, the story of “angels among us” contributed to the credibility of this study, serving as a counter-story to the stories of participants being marginalized in the birth experience.

While feminist narrative research is not concerned with discovering an ultimate truth, it still retains a requirement that its findings are not fabricated and disconnected from any sense of collective reality. For this study, an audit trail including transcripts, tables for data analysis, and all drafts of analysis have been created and kept so that the veracity of the data can be evaluated (Creswell & Poth, 2017).

Transferability

Transferability refers to how the findings of the study are described in rich detail, so that the reader/reviewer may decide if the information provided might apply in

different contexts (Creswell & Poth, 2017; Given & Saumure, 2008; Lincoln & Guba, 1985). This is different from the idea of generalizability where the goal is to extend and apply the findings of the research to a broader population, which is not a concern of this type of research, and the focus was generating and reporting on depth over breath of