Project Story: Battles over Birth

Challenging the assumption of a standard birth

As the study progressed, it became clear that although Finland can be considered a model country for childbirth as far as physical safety in labour is concerned, the system is based on an assumption the project researchers call ‘standard hospital childbirth’. In other words, the starting point for obstetric care in the health system is in-hospital vaginal delivery.

Attitudes to home births and Caesarean sections carried out at the request of those expecting a child vary in the health sector, but the expectant person themself has limited influence on their implementation. According to Eeva Itkonen’s findings in their on-going doctoral dissertation, those expecting a child who wish to have a Caesarean section spend much of their pregnancy anxious and uncertain of whether they will have to go through a vaginal delivery against their will.

“From the point of view of the birth-giver, the decision on a Caesarean section is made too late,” Itkonen says. 

According to the project’s researchers, however, Finnish childbirth culture is undergoing a transformation. The assumption of a standard birth has begun to be called into question.

“The analysis already carried out shows that a major flaw in the care system is related to the view of humans on which the care of those pregnant, birth-givers and persons who have given birth is based on a systematic level. The care system is founded on a rationalised, genderless and agenda-driven view of the human that seeks equality but is blind to the physical and psychological needs of birth-givers. For example, insufficient attention and resources are devoted to preparing for and recovering from childbirth. The assumption seems to be that information alone is enough,” says Kaisa Kuurne, the project leader.

“Principally, the care is well organised, but in a fragmented system, human needs, such as a sense of psychological safety, are not that well addressed,” they continue.

“In Finland, there are many bad social practices hidden from view under the assumption that the rights acquired by women mean that equality has been reached,” says Keiju Vihreäsalo.

“Beneath hard-won rights, such as long family leave, is the price we pay for thinking that the process is now complete. We are living in a sort of in-between phase, where we have become complacent with the great achievements made, when instead the rights gained could be seen as steps that need to be followed by more steps.”

Building a community

Kuurne explains that the aim has been to open doors to people from different backgrounds – whether they are students, researchers at the university or other professionals.

“We have had a huge number of people contact us,” Kuurne says. People who have shown an interest have been included in the networks that have risen around the project. 

“To us, this project is a community,” they sum up, adding: “I also think that birth is something that belongs to everyone. As researchers, we have no ownership of it.” 

Finnish Network for Birth and Childbearing Research (BIRRES) has grown rapidly and has about 50 members from various fields of inquiry ranging from social sciences, to medicine and health science, to psychology and educational sciences. Fifteen theses alone have been completed or are currently in progress.

The network, which meets monthly, provides a collaborative hub for academic exchange and advice.

Cooperation with actors in the field of childbirth has deepened, as the project researchers have been invited, for example, to speak at a series of morning lectures at the Women’s Hospital in Helsinki, at midwives’ training days and at a working group focusing on improving patients’ self-determination in the maternity wards of the Hospital District of Helsinki and Uusimaa.

The cooperation network is also working on forming an organisation that will promote the interests of birth-givers in health care. It will be the first of its kind in Finland.

“To go where there is the power to shape policies”

One of the shortcomings identified by the project researchers is the lack of continuity of care: the gap between the maternity clinic and the maternity hospital is too wide for birth-givers. In many other European countries, the starting point is that the same familiar and safe professional or team takes care of the birth-giver before, during and after the birth.

“The Finnish model is a factory model, where pregnant persons are transferred from the maternity clinic to a strange new place with strange new people to give birth, and then to a new ward where they interact with new medical staff working in shifts,” Kuurne says.

If there is a lack of continuity of care and this results in problems not being identified in time, there is a risk of problems accumulating later.

The researchers did not sit idly by, waiting to hear from decision-makers. Instead, they chose to make direct contact with the people who make decisions, for example on the provision of care.

Kuurne believes in direct contact: “The idea is to go where there is the power to shape policies,” Kuurne says, further elaborating on the approach: “We explore and highlight the different kinds of need for change that birth-givers have expressed, but we are also prepared to help make the changes take place.”

In cooperation with various actors, the project sought to start from the premise that it is not just issues that converge but people too.

“It’s worth getting to know the people you want to work with to effect change,” Kuurne advises.

“It creates a safe space in which parallels can be created between different points of view in discussions,” PhD candidate Johanna Sarlio-Nieminen adds.

Freedom means danger and radical trust

The researchers in the project have appreciated the freedom to seize the moment and approach topics that have been of interest to the public at any one time. The ‘me too birth’ movement made the researchers take a closer look at the tensions behind the debate that stirred so many emotions. They found that the debate on abuse during childbirth was just the tip of the iceberg.

The freedom of the researchers to feel emotions themselves has also played a role. Sometimes, the driving force behind research and the activities that go with it can be a strong emotion. In the current project for Kuurne, who put the working group together, this driving force was the shock of discovering that, in the wake of the uproar of birth-givers and persons who have given birth and the ensuing media debate, a pregnant person in Finland still cannot trust that they will have a say in their own labour.

As a researcher, Kuurne does not plan very far ahead. For them, research is about being aware of the silent signs that indicate issues emerging in society right now.

Kuurne describes this approach to research as radical trust and, at the same time, as a dangerous life for an academic, because rapid publication and securing career transitions are not always compatible with it. That is why there is also freedom in the fact that the funder does not require the researchers to stick to the plan on the basis of which they applied for funding. 

Freedom is also the opportunity to create your own community.

“None of us in this project believe in an agenda-driven, status-oriented way of doing research anymore. Whenever humans are involved, there will be emotions, human life, connections and values,” Kuurne says.

As the project leader, equally important as the research output to them is the fact that the people involved in the project can research the things that call to them. This ensures a good performance and gives researchers an internal sense of doing relevant work. 

A way of doing things that recognizes people as multidimensional beings has been crucial not only for working with different stakeholders, but also for the formation of the project team.

Anna Leppo, who started working in the field of non-profit organisations after completing her doctoral thesis, says that returning to academic research was not a foregone conclusion.

They was attracted to the project by the practices employed that challenge the academic performance-oriented culture.

“For us, things like rest, relaxation and physicality in general are important,” Kuurne says. Work in the project is organised in cycles: at times the researchers work very intensely and at other times they slow down and let their mind and body recover.

“And that’s why we felt it was a good idea to return to the university,” Vihreäsalo laughs.

“Freedom is creating a pocket where there is room to explore socially important issues and make the world a better place without having to constantly think about your academic performance,” Kuurne says.

Contact

Project leader Kaisa Kuurne
kaisa.m.kuurne@helsinki.fi
https://www2.helsinki.fi/en/researchgroups/birth-and-childbearing