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Improving Childbirth Conditions through Better Communication

1. Summary of the impact

Staehler’s research uses philosophy as an instrument to better understand the experience of pregnancy and childbirth, and to improve the experience of labour. Her work has directly expanded the resources of midwife training through her partnership with the Royal College of Midwives (RCM) where she devised, designed, and developed an online module ‘Communication in Labour’ (already completed by over 700 midwives). The module provides reflexive tools that enable midwives to communicate more effectively within their professional practice. The success of the module has led to an expanded version being launched in 2021. Staehler’s research has also contributed to policy development in the UK and has created new spaces for interdisciplinary and public discussion of childbirth experience in the UK, Austria and Germany.

2. Underpinning research

Prof Staehler is internationally recognised for her work in continental philosophy with significant expertise in existential phenomenology. Since 2010 she has conducted research on the experiences of pregnancy, childbirth, and being with infants, using interviews, phenomenological auto-ethnography, and the analysis of affect in existential phenomenology (primarily in relation to Heidegger). Staehler’s research has long involved considering the implications of classical philosophy and more contemporary philosophical thought for the present (see [R1], for instance). In relation to childbirth, her key innovation has been to bring her phenomenological philosophical method to the challenges of communication during childbirth [R2, R3]. She has consistently demonstrated the usefulness of phenomenology’s core focus on the body and embodiment for enabling new perspectives on birth, for parents and siblings but especially for the practice of midwifery and the pivotal relationship between expectant mother and midwife during birth itself [R2, R5].

Pregnancy and childbirth generate particular communication challenges, not least because it is difficult to communicate emotions during such an intensely intimate and extraordinary bodily experience (often experienced as affective turmoil) [R4]. Childbirth is an experience during which we depend on the help of others (partners, midwives, doulas [birth helpers], obstetricians), and how we feel treated by them has a profound effect on our well-being. Staehler’s research is guided by two main questions: (1) How can pregnancy, birth, and being with newly born infants be described beyond the merely personal and outside of the medical? (2) What characteristics or structures does such a description reveal? What emotions are involved, and how can we maximise productive emotions like wonder yet minimise anxiety and shame? These questions have led her in interdisciplinary directions, exploring how the experiences and emotions around how childbirth can be communicated through Butoh dance, for instance [R5], as well as contemporary visual art [R6]. Her research on phenomenological approaches to childbirth has been published in both English and German [R3]. She has been invited to speak in Denmark, Germany, and Austria, and to teach a postgraduate module for students of Care Studies ( Pflegewissenschaften) at the University of Vienna.

Staehler’s research around pregnancy and birth takes the context of professional health care as one of its central concerns. At the heart of her work is the recognition that bodies can be both perceiving (subject) and perceived (object). The difference between being perceived as an object and perceiving as a subject proved particularly helpful in discussions with stakeholders as it is a challenge in healthcare contexts: mothers want to be taken seriously as subjects, but they also realise that healthcare professionals necessarily attend to their bodies as objects. Deliberate reflection, and specific attention to the perspective of the other, is enabling for midwives and mothers alike. Learning to interact through considerate verbal communication as well as through body language [R2] and recognising the complex and uncanny emotional landscapes involved in birth (anxiety, fear, shame, wonder) has contributed to the RCM’s ‘Better Births’ campaign, a 5-year plan to improve maternity services in England, launched in 2016. In this way Staehler has been able to bring philosophical ideas out of the academy and into practical dialogue with expectant mothers and with healthcare professionals, many of whom have little or no prior experience of the subject, and make a material difference to their lives.

3. References to the research

R1. Staehler, Tanja, Plato and Levinas: The Ambiguous Out-Side of Ethics. London: Routledge, 2010. 284pp. ISBN 9780415991803 Paperback 2015. Available on request.

R2. Staehler, Tanja, “Passivity, being-with and being-there: care during birth”. 2016. Medicine, Health Care and Philosophy. Vol. 19 (3), pp. 371-379. DOI: https://doi.org/10.1007/s11019-016-9686-5

R3. Staehler, Tanja, “Vom Berührtwerden. Schwangerschaft als paradoxes Paradigma.” 2016. In Dem Erleben auf der Spur. Feminismus und die Philosophie des Leibes, ed. H. Landweer & I. Marcinski. Berlin: transcript, 2016, pp. 27-44. Available on request.

R4. Staehler, Tanja, Who’s afraid of birth? Exploring mundane and existential affects with Heidegger”. 2017. Janus Head, Journal of Interdisciplinary Study in Literature, Continental Philosophy, Phenomenological Psychology. Vol. 16, issue 1, pp. 139-72. Open Access: http://www.janushead.org/16-1/Staehler.pdf

R5. Staehler, Tanja, “Exploring Pregnancy with Phenomenology and Butoh Dance.” Yearbook for Eastern and Western Philosophy. Special Issue: Embodiment East/West, de Gruyter, 2017, issue 2, pp. 35-55. https://doi.org/10.1515/yewph-2017-0006

R6. Jennings, Phineas and Staehler, Tanja, “On Louise Bourgeois’ ‘The Reticent Child’ and Shame”. Art in Print, 2019, volume 9, number 3, pp. 22-23. Available on request.

4. Details of the impact

Providing New Resources in Midwife Training and Expanding the Reflexive Capabilities of Midwives

Although giving birth is a common experience for many women, it is often accompanied by a sense of shame, anxiety, and fear. The care that birthing mothers receive from midwives is profoundly important, not just in terms of the medical attention they may need, but also in relation to emotional support and mental well-being. Good communication is of fundamental importance in this context and aspects of philosophical thought, especially those that speak to the strangeness of giving birth, can be a tool to help midwives better support parents in this potentially life-defining moment.

In 2015 Staehler was commissioned by the Royal College of Midwives (RCM) to design and develop an online training module for them, founded upon philosophical concepts and responsive to the distinctive working patterns of midwives [S1]. She conceptualised the module and developed the initial content for it, inviting speech communication specialist Dr Alexander Kozin to collaborate in its further development and delivery. The use of philosophy in RCM training was entirely new and attracted significant media coverage including a feature in the Brighton newspaper The Argus, interviews on BBC Radio Sussex and BBC Radio Ulster, and a report in The Times entitled ‘Sartre to give helping hand in labour room’ [S2].

Staehler’s RCM module, ‘Communication in Labour’, was launched through the RCM i-learn platform in November 2016. It consists of 15 short videos and an electronic diary for self-reflection. It explains why communication matters so much within the birthing situation, explores the links between communication and emotions, and considers why women feel particularly vulnerable in this context. It uses philosophical ideas such as Heidegger’s distinction between fear and anxiety and Sartre’s idea of ‘object’ and ‘subject’ as mechanisms for reflecting on, and changing, midwifery practice. A key concept is that of ‘responsivity’, and the module encourages midwifes to react according to what the mother wants rather than what they assume she wants. This necessitates reading body language and using touch as much as communicating verbally. To date over 700 RCM members have undertaken the module [S3]. The success of this module is demonstrated by the RCM’s decision to release an expanded version in Spring 2021, incorporating feedback from midwives and additional material on body language. The latter section of the module had had a particularly notable impact on midwifery practice, and – through practice – on the direct experience of mothers.

For RCM’s professional advisor in education, [text removed for publication], the module ‘achieved exactly what we wanted’: a ‘genuine reflection on communication’ and ‘a deeper and more ethically nuanced exploration of the process of communication in labour from both the woman and the midwife’s perspective’ [S4]. Like all healthcare professions, midwifery training (and its continual development) is based around self-reflexive practices. For [text removed for publication], what was so transformative about Staehler’s module was that it provided the conceptual tools for improving this essential aspect of midwifery. It exposed midwifes ‘to the rawness of the whole experience as a foundation’ while it also ‘clarified things’. Tools of clarification and tools that develop self-reflexive thinking are precisely what the module offered, and for [text removed for publication] ‘that is invaluable’ [S4].

[text removed for publication]’s assessment is mirrored by the midwives who undertook the training. For some of the student midwives it offered ‘fantastic explanations’ and ‘provided me with ideas of better ways to communicate’ [S5]. The module expanded the communicative options for midwives, importantly in the area of phatic, non-verbal communication: ‘reminded that one can communicate attentiveness without speaking, through human touch’ [S5]. For more experienced midwives, it clarified some of the intuitive practices that they had developed over years (‘made me feel that I'm doing a great job’), while offering ‘ways to improve and provide an even better experience of being heard for the women in my care’ [S5]. The module’s ability to reaffirm caring ‘instinctive’ practice should not be overlooked: ‘I felt that this module boosted my confidence in my ability to communicate with women’ [S5]. Some participants wrote directly to Staehler to explain the impact that the module had had on their practice: a midwife with 18 years’ experience connected with the content from ‘both a personal and professional perspective’; a year three student said it made her ‘more self-aware and more perceptive’ adding, ‘I will certainly keep your ideas in mind when I am attending to women in labour [S6].

Developing New Understandings for Psychotherapy

The productive interconnection between philosophical research and practical experience has further generated new ways of communicating and conceptualising the birth experience and has led to a fruitful involvement with psychotherapists and counsellors. Staehler’s writing on existential phenomenological methodology, including its presentation to a 2017 Inner Circle psychotherapy workshop organised by [text removed for publication], has allowed therapists and counsellors to clarify aspects that are foundational to their practice. As [text removed for publication] explains, ‘by focussing on childbirth in particular, Tanja’s work yields valuable insights which have already had a noticeable impact on the rather impoverished ways of thinking, both existential and psychoanalytic, in this field’ [S8]. Another existential psychotherapist describes Staehler’s work as ‘very unusual in linking something very philosophical to something very practical’ and suggests that it demonstrates ‘the value of philosophy in reframing our understanding of motherhood’ [S8]. Her international presentations on interdisciplinary methodology, her examination of research degrees in Psychotherapy and Counselling, and her instruction of nurses taking Care Studies ( Pflegewissenschaften) at the University of Vienna, have further extended the reach of her contribution to professional development [S9].

Informing Policy in the UK

The work with midwives informed Staehler’s submission of evidence to the House of Commons, Women and Equalities Committee’s Pregnancy and Maternity Discrimination enquiry in 2016. Her submission focused on some of the attitudes that discriminate against women returning from maternity leave which are articulated in seemingly innocuous manners of speech. These everyday communicative acts often appear incidental but can have profoundly harmful effects on women. The final report’s insistence that, alongside offering practical support in addressing pregnancy and maternity discrimination, there is a clear need for ‘awareness-raising and attitude-changing’ [S7 p.56] through communicative practices is directly indebted to Staehler’s prioritising the experiential aspects of linguistic and non-linguistic communication.

Staehler’s research is resonating beyond healthcare contexts to influence the public discussion of childbirth in the UK. Alongside her innovative use of the press coverage of her project to facilitate a public conversation about childbirth and encourage women to communicate their experiences (‘Meet the Professor who wants you to share your birth stories’, September 2019), Staehler organised a well-attended Brighton Fringe Festival event in 2017 called ‘Sussex Birth Day: Talking about Birth Matters’, which brought midwives, parents and birth activists together for sustained discussion [S10]. Staehler has been able to use her public platform (as well as her dedicated website: www.birthsite.org) to encourage women to narrate their own experiences of childbirth, accounts that form the basis of a collection that she is editing for publication in 2021. These important initiatives, which bring philosophy to the experience of childbirth, and childbirth to philosophy, are reaching new and expanding constituencies.

5. Sources to corroborate the impact

S1: ‘Communication in Labour’ module. http://www.ilearn.rcm.org.uk/enrol/index.php?id=319, accessible only to the Royal College of Midwives members, plus table of contents.

S2: Press coverage of module:

  1. Tom Whipple, ‘Sartre to give helping hand in labour room’, The Times, 5th November 2016, https://www.thetimes.co.uk/article/sartre-to-give-helping-hand-in-labour-room-fz3fqgn3x; paywall – copy in evidence folder

  2. Siobhan Ryan, ‘Philosophical guide to midwives during birth’ 4th November 2016, The Argus, https://www.theargus.co.uk/news/14843426.philosophical-guide-to-midwives-during-birth/

S3: Module user numbers. Email. 31 May 2019

S4: Testimonial from [text removed for publication], RCM, 10 December 2020

S5: Anonymised module feedback.

S6: Emails from module participants. (1 March 2019; 30 November 2016; 15 September 2017; 24 July 2018)

S7: House of Commons, Women and Equalities Committee, Pregnancy and Maternity Discrimination, First Report of Session 2016-17 (August 2016)

S8: Impact statements from psychotherapists [text removed for publication] 2020

S9: Emails from Austrian MA Care Studies students

S10: Evidence related to public engagement https://issuu.com/brighton_fringe/docs/brighton_fringe_brochure_2017 and www.birthsite.org

Additional contextual information