Rebroadcast: Discourse: Ways of Speaking and Ways of Being in Birth

This episode is a rebroadcast of Episode 4, Discourse: Ways of Speaking and Ways of Being in Birth. Sara explains the linguistic concept of discourse (and Discourse) and what that looks like in a birth setting. Listen to this episode to learn more! REFERENCE: Gee, J. P. (1999). An introduction to discourse analysis: Theory and method. (Fourth Edition, 2014). London: Routledge. TRANSCRIPT: We are going to talk today about a man named James Paul Gee. He is a notable linguist--he's still around today, and he did a lot of work in defining a term called “discourse.” So, Gee differentiates between Little D “discourse,” as in the word “discourse,” spelled with a lowercase D, and Big D “Discourse,” as in the word “Discourse” spelled with a capital D. So little D discourse is simply language in use, that is, in its context, and I say simply, but it's really not so simple. We can analyze language within a specific context and that is called studying discourse. Then Gee talks also about big D Discourse, which he uses to include not just language in a context but all of the other semiotic systems at work in that context. So you remember, in an earlier episode, we talked about how language is a semiotic system. It's the use of signs, symbols, words are really signs or symbols to communicate meaning. And Gee talks about how the words we use are not the only things that communicate meaning in a given situation, and that come into play when we're communicating. So, for instance, police Discourse--big D Discourse—includes not only the way that police officers tend to talk, officially, what types of words they tend to use, the way they tend to structure sentences and phrases, but also, the police uniform, the police car, values that are typically held by a police officer, and behavior that tends to go along with a police officer. So Gee talks about how when you think about what Big D Discourse means, it's basically what would you need to imitate to pull off impersonating somebody in a different… that isn't who you are. I think he talks about being like, a mobster or something, and how if he said the right phrases that are typically used in that context, but wore the wrong clothes, he wouldn't be taken seriously. Or vice versa, wearing the right clothes, saying the wrong things, not following all of the different sign-giving systems that indicate identity and how you operate within a context. So let's talk about the two big D Discourses as they relate… that come up a lot in birth. So I say to I think that many who work in birth would agree that there are two prominent discourses, but also that they're not wholly separate or different from one another. So one researcher, actually two working together, put it this way: “People who work in labor and delivery are fluent in two dialects, they can converse in either and they can talk reflectively about and across them.” So what are these two dialects as McCaffrey and Mannion termed them or Discourses, as Gee would them, and as I'm calling them today? The first is the medical discourse of birth. It includes things like terminology that's used more in a medical birth setting, it tends to take place in a medical scene: in a hospital, or during pregnancy and the physician’s clinic. Terms are used, such as dilation, effacement, contraction, pain level, fetal tracings, amniotic sac, gestation, amniotomy cervical change, and lots of others. Many more complex and jargon-y than the ones that I that I listed. It also comes with other contextual factors: scrubs, a hospital, a hospital bed, hospital equipment, interventions that are commonly used in this setting, such as epidurals, such as amniohooks to break water, such as fetal and contraction monitors for tracing fetal heart tones and intensity and frequency of contractions. Along with this Discourse—this package—comes beliefs. About when the intervention is good or needed. The role of a care provider in relation to the patient who, in this situation a birthgiver is positioned often as a patient in this discourse. There are beliefs, also, that tend to come in this package, about the ability of the birthgiver to birth without intervention, who is in a position of authority and what is the nature of birth. And I'm not going to spell out what each of those beliefs might be, because they are unique to each individual practicing within this Discourse. And it's not necessarily true that they come as a package and each care provider has all of them. But the language used in this discourse often reflects the prominent beliefs and values that are found within this discourse, and which this discourse tends to see birth more as a medical condition that needs to be treated. (And I want to thank Dr. Stephen Roushar of FLOW chiropractic in Lehi, for his help with this terminology that differentiates between these two Discourses.) The medical Discourse, again, is the Discourse which sees pregnancy and birth as a medical condition to be treated. Whereas the other Discourse that I've been referring to is a physiological Discourse, which sees pregnancy and birth as a physiological process to be supported, in contrast to that condition to be treated. So moving on to this second Discourse, physiological birth. There are terms that come along with this Discourse. And again, these terms are not used by everyone within the Discourse, and there's a lot of variability, but terms like wave and surge instead of contraction often are found in this Discourse. Sometimes people in this Discourse speak of opening rather than dilation, as it has a more natural connotation. And some within this Discourse, we tend to differentiate, differentiate between the intense and powerful sensations felt during labor and pain. They don't identify the uterus’s contractions or waves or surges as pain but rather as pressure, intensity. And something that's acknowledging that the body is doing the work that it needs to do, whereas pain tends to convey the opposite message about what's going on in the body. Pain is normally indicative of something being wrong in the body, something that needs to be fixed, whereas, in the birth process physiologically, pain is—the intensity of those feelings—is not an indication that something's going wrong, but rather that the body is working just as it should, in this process. Also, within this Discourse, it comes along with other contextual factors. Scrubs are not worn as often, maybe more of just layman's clothes, and birth can take place in the hospital and this Discourse can be used. But often this Discourse is found in a home birth or a birth center birth. And there may still be some of the same equipment and interventions, but not many of the same. And there are different beliefs within this Discourse about intervention and its role, when it's good when it's needed. There are different beliefs about the role of a care provider in relation to the client, as they're normally called, in this scenario, in this Discourse. And there are different beliefs about the ability of the birth giver to give birth without intervention, who is in a position of authority, and what is in what is the nature of birth. So, these two Discourses operate in a parallel way, they also intersect all the time. The two Discourses can exist in the same place at the same time, and sometimes even in the same person. Or a person may subconsciously, without realizing it, be speaking the language of one Discourse while identifying themselves or finding their beliefs within the other Discourse. So, throughout this podcast, we'll come back to this concept of Discourse. And we'll keep thinking about what our language reveals about our underlying beliefs. And what how we position birth givers and what the role of authority figures is. And so I'm excited to keep going with you on this journey as we look at language and birth. See you next week.