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Social Support and Motherhood: The Natural History of a Research Project
Drawing on her long experience as an academic researcher and writer, Ann Oakley develops a sociology of the research process itself, telling the story of how a research project is undertaken and what happens along the way to both the researchers and those who are being researched. This remarkable book focuses on a topic of great importance in the provision of health services: caring and social support. Placing the widespread neglect of this topic in the wider context of an ongoing crisis in gendering knowledge, Social Support and Motherhood is now being reissued for a contemporary audience, to emphasize its resonance for social science researchers and others interested in the experiences of mothers, and in the relations between social research, academic knowledge, and public policy.
404 pages, Hardcover
First published January 1, 1992
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August 24, 2020
This book examines a research project from its inception through to its eventual conclusions and impact. In each chapter, it examines critically aspects of the process by which social research is conducted, funded, adapted to meet expectations from different stakeholders, the way the research process affects and is affected by diverse participants, the way research findings are expressed and interpreted and the ways they change or fail to change social realities.
I have become a fan of Ann Oakley. This book illustrates that she is a great communicator and educator: she handles difficult material without sinking into professional jargon. It demonstrates that she has a remarkably firm grasp of research methodology, resulting in findings that stand up to hostile scrutiny; this is critically important because her work is not a matter of opinion or ideology, it is built on and part of a rigorous tradition of social science. When I studied psychology in the 1970s this book (published alas in 1992) would have helped me enormously.
Once absorbed in the methodology of this project, a really strong sense emerges of the battle of ideas and the reasons why research methods are so central to everything else. They are the techniques by which a scientist confronts and overcomes scepticism to arrive at useful knowledge about the world and in Oakley’s work it becomes evident that this was from the outset a battle hard fought against entrenched interests; that is really exciting stuff to my mind. Oakley was telling powerful men stuff they did not want to hear and reports of her little victories are hugely entertaining.
The book makes it obvious that Oakley had to be a feminist writer, not because her work lacked scientific rigour, but because it challenged and exposed the failings within a field dominated by male experts and their patriarchal frame of reference. Feminism was not only an unavoidable reaction on her part to unjust male obstruction throughout her project, but also – and importantly – a label used by male authorities to marginalise and then ignore work that systematically refuted their claims to control of knowledge and hence to power. Oakley actually refutes in her work and her commentary the very notion that there is a distinct entity to be called “feminist science.” There is instead science that men want to entertain and science they want to marginalise and ignore. Popper’s wishful theory that true scientists will change their opinions in the face of evidence is itself falsified when Oakley exposes a world where only men can be true scientists. Oakley the woman is a feminist, but professionally she just is a great social scientist.
The insanity to being shouted down by male experts is all the more intense because the subject of this research project is childbirth and a major part of the research concerned the way women experience this process, through antenatal and postnatal healthcare systems and institutions. Oakley formed the interesting hypothesis that if women enjoyed helpful, non judgemental social support through this process, the improved experience would be reflected in better health outcomes for both mothers and babies, something that in some but not all perspectives should be welcomed by everyone involved. She was able to demonstrate this very successfully and, sure enough, this was intensely unwelcome to many male interests with a professional stake in the childbirth industry. The problem is not that men want to harm women – although there is plenty of evidence they do, as examined in this book – but that they want to control them even – especially – in the most definitively female of all aspects of their lives.
Oakley presents many types of evidence in her report from this research, quantitative as well as qualitative, fully conforming to the scientific method in every respect. For a reader, though, arguably the greatest impact comes from the many transcripts of the words spoken by women in the study, both as mothers and as support workers / midwives. These expose not only the experience of bearing a child in itself but of doing so in the context of a life that is utterly unyielding and unsupportive. Unlike a pregnant pig in its pen, women bear children in the midst of a complex and demanding, often stressful and rarely helpful lifestyle that is simply ignored rather than resourced; they have to get on with it and it is pointless to complain.
It would be nice to report that Oakley’s masterful research would have or could have transformed this situation, now that we know what was previously hidden, but anyone reading (for example) Tristram Shandy and its account of the conflict between a male surgeon and women midwives at a childbirth in 18th Century Britain, will realize that we have always known. I think the point may be made more simply – it’s not about the women, it’s about control.
Quotes
Published versions of research in both the social and natural sciences are forms of reconstructed logic... –jumping out of the bath and shouting ‘Eureka’ is not, after all, something to be emphasised in a sober scientific journal. The notion of intellectual work as a simple unilinear process is part of the problem – part of the misleading ideology of the ‘rational’ scientist mode of knowledge...[p18]
Studies which pay some attention to what is called the placebo response are also studies about social support and health... Evidence that both interviews and placebos can make people feel better (or worse) is profoundly disturbing to the philosophy of the body-mind dichotomy... [p31] ... ...the chief interest of ‘scientific’ medicine has not been in exploring the placebo effect as evidence of the interconnectedness of mind and body, but in excluding it from its domain precisely because of its proven therapeutic effectiveness. [p35]
I felt very inadequate, that I couldn’t carry a child, and this time I hope I can, just to see what a normal pregnancy is like. Because everyone says that being pregnant is the most wonderful experience for a woman. [p103]
We took as our baseline a clear, negative definition of social support: social support was not clinical care, it was not anti-smoking advice, marital counselling or a strategy to encourage women to make more use of the antenatal service. Thus the research midwives were asked not to do any of these things. What they were asked to do was listen to what the women had to say and to be responsive to any self-defined needs and perspectives. Social support was defined as the provision of a non-judgemental listening ear, discussing with women their pregnancy needs, giving information when asked to and carrying out referrals when appropriate to other health and welfare professionals and voluntary and statutory agencies. [p144]
Just as the hiding of the fetus in the mother blocked the scientific gaze of obstetricians, so the containing of the infant’s nutrition in the female breast frustrated the scientific claims of paediatricians, For behind the move to quantify infant development lay the emergence of a group of professionals - paediatricians – who were in the business of building up a basis for their claims to knowledge which could be held up as superior to anyone else’s, and particularly mothers’...[p254]
Schools, hospitals and clinics gave childhood a special status it had not had before, and justified the incursion of the state as moral guardian into the private lives of families. [p255]... So far as weight at birth is concerned, a fundamental moral notion is that of ‘normal’ birthweight, with its accompanying negative category, that of ‘low birthweight.’ [p257]
On average only between 10 and 30 percent of women identified as at risk by formal risk-scoring systems do develop problems, whereas between 20 and 50 percent of those who give birth to preterm or low-birthweight babies belong to the ‘low risk’ group... No medical prediction schemes include an evaluation of risk by women themselves. [p269]
The stories the women told about their medical care repeat well-known themes concerning impersonal treatment, inadequate information, protracted waiting times, and a general lack of consideration for other aspects of women’s lives apart from their pregnancy. [p272]
As Bonny Howarth phrased it: “[you need] more help at the antinatal [sic] clinic. It’s like a cattle market on a good day, and it’s so degrading. They should treat everyone as human beings. They forget it’s people like me that keep them in a job.” [p280]
But, if medical attempts to predict risk are, as we have seen, relatively unsuccessful, do the women’s own perceptions fare any better? ... How women feel about their pregnancies early on is related to what happens to them and the their babies. [p300]
The underlying problem is that facts do not speak for themselves. And ‘facts’ as such do not exist independently of perception and social construction. [p301]
One main reason for undertaking a ‘trial’ of social support was that so many other trials of medical interventions aimed at improving the health of women and babies came up with negative findings... Social support as prevention for the health damaging effects of stress is benign, whereas medical interventions, if not efficacious, may be harmful. [p303]
...there is no such thing as a definitive study. Knowledge is pushed forward a little at a time, not (usually) by quantum leaps. Ideas generate research which produces more ideas for further research. Each piece of research is unique, making a contribution to the whole picture on the basis of sketches and blueprints provided by others. [p305]
The material poverty of the women who took part in the SSPO study emerges clearly in both the quantitative and the qualitative date drawn on in this book. Not only did many of them lack the material resources to provide for themselves and their families anything other than a health denying quality of life, but the practical shortfalls were matched by the cultural under-resourcing of both gender and class. From the point of view of women’s passages to motherhood, a classist, sexist and racist medical system (Doyal 1979) simply does not, and cannot, attend to the voices and needs of those who are perceived to be on the margins... [p314]
...government reports are the end-product of a process of political control in which government departments are increasingly attempting to excise from the doing and writing up of research any elements that are antipathetic to the political philosophies they espouse. [p320]
The individualist discourse of health education, which has increasingly dominated health policy since the 1950s, provides a powerful ideological smokescreen behind which environmental constraints on achieving health are veiled as matters of individuals’ irresponsible choices. Health is primarily a mtter of lifestyle not living conditions. Individuals are free to make healthy choices and are morally culpable if they do not do so... The smoking mother encapsulates the cultural problem of reproduction and of women – purity and danger – and provides an iron smokescreen for the concealment of the fundamental problem that women cannot be good mothers unless motherhood (and women) is resourced and respected on an equal basis with male citizenship. [p320]
The studies reviewed in chapter 3 demonstrate the falsity of the notion that the only domain the social can affect is the social. ‘Social’ interventions promote physical health. They promote psychological, emotional and social manifestations of health as well, which is hardly surprising given the inappropriateness of the Cartesian mind-body dualism to the way in which most people experience living in their bodies. [p325]
The pseudo-technical language of social support as distinct from the lay formulation of friendship is probably important here – seeming, as it does, to provide a professional justification for ‘folk’ wisdom. It dresses up what most people know into something that a few have recently discovered. [p326]
If listening to women’s worries, visiting them at home and providing continuity of care are shown to be beneficial, then where does this leave obstetricians, who generally speaking do none of these things? [p328]
In the SSPO study all our documentation of the processes of giving and receiving the social support interventions suggest that the following pathways were significant: first, by providing a listening ear, the research midwives helped the intervention women to cope better with stress, and to gain more confidence as individuals, as mothers and as users of the health care system... A second, related pathway was the efforts of the research midwives to make more appropriate use of health care... The research midwives were concerned both to protect intervention women from ‘unnecessary’ medical procedures and to help them obtain ‘necessary’ ones. [p329]
...controlled experimentation is preferable to the uncontrolled experimentation that goes on under the heading of routine practice – whether in medical, educational, social welfare or other fields. Most of the interventions introduced into people’s lives have ridden on the backs of professionals’ claims of clear benefits, not founded on the back of controlled evaluations that have established their effectiveness, appropriateness and safety. [p330]
Behind the conventional, commonsense view of knowledge in developed societies are certain assumptions, among which the following are critical:
1. Knowing involves representational naming...
2. To name is to classify ...
3. Classified units are equivalent to one another ...
4. Classificatory and conceptual schemes allow the deduction, induction and enumeration of facts ...
5. Facts exist. That is, facts are absolutely true ... [p334]
As Wolf Lepenies (1988) has argued, a significant factor in the ‘physicalization’ of sociology was the competing representation of subjectivity by literature; while sociology was concerned with fact, novelists and poets dealt with feelings. ... battle lines were drawn between ‘sociology [as] a discipline characterized by cold rationality, which seeks to comprehend the structures and laws of notion of modern industrial society by means of measurement and computation and in doing so only serves to alienate man [sic] more effectively from himself and from the world around him,’ and, on the opposite side, ‘a literature whose intuition can see farther than the analysis of the sociologists and whose ability to address the heart of man [sic] is to be preferred to the products of a discipline that misunderstands itself as a natural science of society.’ [p339]
I have become a fan of Ann Oakley. This book illustrates that she is a great communicator and educator: she handles difficult material without sinking into professional jargon. It demonstrates that she has a remarkably firm grasp of research methodology, resulting in findings that stand up to hostile scrutiny; this is critically important because her work is not a matter of opinion or ideology, it is built on and part of a rigorous tradition of social science. When I studied psychology in the 1970s this book (published alas in 1992) would have helped me enormously.
Once absorbed in the methodology of this project, a really strong sense emerges of the battle of ideas and the reasons why research methods are so central to everything else. They are the techniques by which a scientist confronts and overcomes scepticism to arrive at useful knowledge about the world and in Oakley’s work it becomes evident that this was from the outset a battle hard fought against entrenched interests; that is really exciting stuff to my mind. Oakley was telling powerful men stuff they did not want to hear and reports of her little victories are hugely entertaining.
The book makes it obvious that Oakley had to be a feminist writer, not because her work lacked scientific rigour, but because it challenged and exposed the failings within a field dominated by male experts and their patriarchal frame of reference. Feminism was not only an unavoidable reaction on her part to unjust male obstruction throughout her project, but also – and importantly – a label used by male authorities to marginalise and then ignore work that systematically refuted their claims to control of knowledge and hence to power. Oakley actually refutes in her work and her commentary the very notion that there is a distinct entity to be called “feminist science.” There is instead science that men want to entertain and science they want to marginalise and ignore. Popper’s wishful theory that true scientists will change their opinions in the face of evidence is itself falsified when Oakley exposes a world where only men can be true scientists. Oakley the woman is a feminist, but professionally she just is a great social scientist.
The insanity to being shouted down by male experts is all the more intense because the subject of this research project is childbirth and a major part of the research concerned the way women experience this process, through antenatal and postnatal healthcare systems and institutions. Oakley formed the interesting hypothesis that if women enjoyed helpful, non judgemental social support through this process, the improved experience would be reflected in better health outcomes for both mothers and babies, something that in some but not all perspectives should be welcomed by everyone involved. She was able to demonstrate this very successfully and, sure enough, this was intensely unwelcome to many male interests with a professional stake in the childbirth industry. The problem is not that men want to harm women – although there is plenty of evidence they do, as examined in this book – but that they want to control them even – especially – in the most definitively female of all aspects of their lives.
Oakley presents many types of evidence in her report from this research, quantitative as well as qualitative, fully conforming to the scientific method in every respect. For a reader, though, arguably the greatest impact comes from the many transcripts of the words spoken by women in the study, both as mothers and as support workers / midwives. These expose not only the experience of bearing a child in itself but of doing so in the context of a life that is utterly unyielding and unsupportive. Unlike a pregnant pig in its pen, women bear children in the midst of a complex and demanding, often stressful and rarely helpful lifestyle that is simply ignored rather than resourced; they have to get on with it and it is pointless to complain.
It would be nice to report that Oakley’s masterful research would have or could have transformed this situation, now that we know what was previously hidden, but anyone reading (for example) Tristram Shandy and its account of the conflict between a male surgeon and women midwives at a childbirth in 18th Century Britain, will realize that we have always known. I think the point may be made more simply – it’s not about the women, it’s about control.
Quotes
Published versions of research in both the social and natural sciences are forms of reconstructed logic... –jumping out of the bath and shouting ‘Eureka’ is not, after all, something to be emphasised in a sober scientific journal. The notion of intellectual work as a simple unilinear process is part of the problem – part of the misleading ideology of the ‘rational’ scientist mode of knowledge...[p18]
Studies which pay some attention to what is called the placebo response are also studies about social support and health... Evidence that both interviews and placebos can make people feel better (or worse) is profoundly disturbing to the philosophy of the body-mind dichotomy... [p31] ... ...the chief interest of ‘scientific’ medicine has not been in exploring the placebo effect as evidence of the interconnectedness of mind and body, but in excluding it from its domain precisely because of its proven therapeutic effectiveness. [p35]
I felt very inadequate, that I couldn’t carry a child, and this time I hope I can, just to see what a normal pregnancy is like. Because everyone says that being pregnant is the most wonderful experience for a woman. [p103]
We took as our baseline a clear, negative definition of social support: social support was not clinical care, it was not anti-smoking advice, marital counselling or a strategy to encourage women to make more use of the antenatal service. Thus the research midwives were asked not to do any of these things. What they were asked to do was listen to what the women had to say and to be responsive to any self-defined needs and perspectives. Social support was defined as the provision of a non-judgemental listening ear, discussing with women their pregnancy needs, giving information when asked to and carrying out referrals when appropriate to other health and welfare professionals and voluntary and statutory agencies. [p144]
Just as the hiding of the fetus in the mother blocked the scientific gaze of obstetricians, so the containing of the infant’s nutrition in the female breast frustrated the scientific claims of paediatricians, For behind the move to quantify infant development lay the emergence of a group of professionals - paediatricians – who were in the business of building up a basis for their claims to knowledge which could be held up as superior to anyone else’s, and particularly mothers’...[p254]
Schools, hospitals and clinics gave childhood a special status it had not had before, and justified the incursion of the state as moral guardian into the private lives of families. [p255]... So far as weight at birth is concerned, a fundamental moral notion is that of ‘normal’ birthweight, with its accompanying negative category, that of ‘low birthweight.’ [p257]
On average only between 10 and 30 percent of women identified as at risk by formal risk-scoring systems do develop problems, whereas between 20 and 50 percent of those who give birth to preterm or low-birthweight babies belong to the ‘low risk’ group... No medical prediction schemes include an evaluation of risk by women themselves. [p269]
The stories the women told about their medical care repeat well-known themes concerning impersonal treatment, inadequate information, protracted waiting times, and a general lack of consideration for other aspects of women’s lives apart from their pregnancy. [p272]
As Bonny Howarth phrased it: “[you need] more help at the antinatal [sic] clinic. It’s like a cattle market on a good day, and it’s so degrading. They should treat everyone as human beings. They forget it’s people like me that keep them in a job.” [p280]
But, if medical attempts to predict risk are, as we have seen, relatively unsuccessful, do the women’s own perceptions fare any better? ... How women feel about their pregnancies early on is related to what happens to them and the their babies. [p300]
The underlying problem is that facts do not speak for themselves. And ‘facts’ as such do not exist independently of perception and social construction. [p301]
One main reason for undertaking a ‘trial’ of social support was that so many other trials of medical interventions aimed at improving the health of women and babies came up with negative findings... Social support as prevention for the health damaging effects of stress is benign, whereas medical interventions, if not efficacious, may be harmful. [p303]
...there is no such thing as a definitive study. Knowledge is pushed forward a little at a time, not (usually) by quantum leaps. Ideas generate research which produces more ideas for further research. Each piece of research is unique, making a contribution to the whole picture on the basis of sketches and blueprints provided by others. [p305]
The material poverty of the women who took part in the SSPO study emerges clearly in both the quantitative and the qualitative date drawn on in this book. Not only did many of them lack the material resources to provide for themselves and their families anything other than a health denying quality of life, but the practical shortfalls were matched by the cultural under-resourcing of both gender and class. From the point of view of women’s passages to motherhood, a classist, sexist and racist medical system (Doyal 1979) simply does not, and cannot, attend to the voices and needs of those who are perceived to be on the margins... [p314]
...government reports are the end-product of a process of political control in which government departments are increasingly attempting to excise from the doing and writing up of research any elements that are antipathetic to the political philosophies they espouse. [p320]
The individualist discourse of health education, which has increasingly dominated health policy since the 1950s, provides a powerful ideological smokescreen behind which environmental constraints on achieving health are veiled as matters of individuals’ irresponsible choices. Health is primarily a mtter of lifestyle not living conditions. Individuals are free to make healthy choices and are morally culpable if they do not do so... The smoking mother encapsulates the cultural problem of reproduction and of women – purity and danger – and provides an iron smokescreen for the concealment of the fundamental problem that women cannot be good mothers unless motherhood (and women) is resourced and respected on an equal basis with male citizenship. [p320]
The studies reviewed in chapter 3 demonstrate the falsity of the notion that the only domain the social can affect is the social. ‘Social’ interventions promote physical health. They promote psychological, emotional and social manifestations of health as well, which is hardly surprising given the inappropriateness of the Cartesian mind-body dualism to the way in which most people experience living in their bodies. [p325]
The pseudo-technical language of social support as distinct from the lay formulation of friendship is probably important here – seeming, as it does, to provide a professional justification for ‘folk’ wisdom. It dresses up what most people know into something that a few have recently discovered. [p326]
If listening to women’s worries, visiting them at home and providing continuity of care are shown to be beneficial, then where does this leave obstetricians, who generally speaking do none of these things? [p328]
In the SSPO study all our documentation of the processes of giving and receiving the social support interventions suggest that the following pathways were significant: first, by providing a listening ear, the research midwives helped the intervention women to cope better with stress, and to gain more confidence as individuals, as mothers and as users of the health care system... A second, related pathway was the efforts of the research midwives to make more appropriate use of health care... The research midwives were concerned both to protect intervention women from ‘unnecessary’ medical procedures and to help them obtain ‘necessary’ ones. [p329]
...controlled experimentation is preferable to the uncontrolled experimentation that goes on under the heading of routine practice – whether in medical, educational, social welfare or other fields. Most of the interventions introduced into people’s lives have ridden on the backs of professionals’ claims of clear benefits, not founded on the back of controlled evaluations that have established their effectiveness, appropriateness and safety. [p330]
Behind the conventional, commonsense view of knowledge in developed societies are certain assumptions, among which the following are critical:
1. Knowing involves representational naming...
2. To name is to classify ...
3. Classified units are equivalent to one another ...
4. Classificatory and conceptual schemes allow the deduction, induction and enumeration of facts ...
5. Facts exist. That is, facts are absolutely true ... [p334]
As Wolf Lepenies (1988) has argued, a significant factor in the ‘physicalization’ of sociology was the competing representation of subjectivity by literature; while sociology was concerned with fact, novelists and poets dealt with feelings. ... battle lines were drawn between ‘sociology [as] a discipline characterized by cold rationality, which seeks to comprehend the structures and laws of notion of modern industrial society by means of measurement and computation and in doing so only serves to alienate man [sic] more effectively from himself and from the world around him,’ and, on the opposite side, ‘a literature whose intuition can see farther than the analysis of the sociologists and whose ability to address the heart of man [sic] is to be preferred to the products of a discipline that misunderstands itself as a natural science of society.’ [p339]
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