Научная статья на тему 'NAVIGATING INSTITUTIONAL INCONSISTENCIES VIA DIFFERENT EMOTIONAL STYLES: COMMUNICATION IN MATERNITY CARE IN RUSSIA'

NAVIGATING INSTITUTIONAL INCONSISTENCIES VIA DIFFERENT EMOTIONAL STYLES: COMMUNICATION IN MATERNITY CARE IN RUSSIA Текст научной статьи по специальности «Фундаментальная медицина»

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Ключевые слова
maternity care / healthcare professionals and organizations / communication in medicine / emotional styles / khamstvo

Аннотация научной статьи по фундаментальной медицине, автор научной работы — Anastasia Novkunskaya

Abstract: Over the past decades, the healthcare system in Russia has undergone multiple changes, affecting both its institutional arrangement and the practice of interpersonal interactions. The commercialization of medicine, consumerization of patient behavior, emergence of new medical approaches (Temkina 2016, 2017), and changes in professional standards of care have created complex settings in which social norms and rules turn out to be numerous and sometimes unreliable. 26 Despite the volatility of this context, some forms of communication between key participants remain stable and have been in place since the Soviet period. In particular, the “Soviet approach” was recognized as paternalistic (Rivkin-Fish 2005). That is, assuming an asymmetry of power between patients and medical professionals, between the latter and the management of healthcare organization, and between entire health care system and the state ideology (Field 1957; Saks 2015). Thus, social and healthcare reforms carried out since the early 1990s have shaped the context of healthcare institutions in Russia, but the latter remains largely “unfriendly” to patients and reproduces inequality at the level of social structures and everyday communications. This study, based on qualitative semi-structured interviews with health practitioners and patients, as well as on a series of observations in a medical center, addresses the sustainability of the rude and unfriendly forms of. In addition, the study describes some forms of undesirable communication between patients and healthcare practitioners, or between representatives of different professional groups.

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Текст научной работы на тему «NAVIGATING INSTITUTIONAL INCONSISTENCIES VIA DIFFERENT EMOTIONAL STYLES: COMMUNICATION IN MATERNITY CARE IN RUSSIA»

The article is based on a qualitative textual analysis of the current situation using the Vkontakte public "Happiness of motherhood", where modern mothers from Russia discuss with each other the practical and emotional problems associated with their parenthood.

Keywords: intensive motherhood, post-Soviet Russia, changes in norms DOI:

NON-MEDICAL CARE FOR WOMEN DURING PERIODS OF BODILY VULNERABILITY AND CHANGES IN

SOCIAL STATUS

Tatiana L. Kuksa

Head of the Legislation Reform Department at Institute for Public Administration and Governance, HSE University, Center of Medical Anthropology, Institute of Ethnology and Anthropology of the Russian Academy of Sciences, Moscow, Russia; e-mail: tutosha@gmail.com

Abstract: The infrastructural, legislative, and financial changes in Russian obstetric care over the past two decades have been accompanied by updated standards, clinical guidelines and medical thinking, the admission of family participation in childbirth and the emergence of new perinatal jobs ("agents of care") outside of biomedical conventions and budgetary institutions. Grassroots self-organization and institutionalization of professional communities (comprising, as a rule, mothers of many children with high educational and social capital, having medical, psychological, midwifery or other competencies) contributed to the popularization of "Odent", "soft", "careful", "patient-oriented" approaches to hospital care childbirth and the emergence of certified doulas with the skills of informational, physical, domestic, emotional support for clients. The possibility of "continuous" and "non-judgmental" non-medical care in vulnerable periods of life expands the agency (choice) and improves the position of a woman when faced with physical and mental difficulties in the family and when interacting with a monopolized and closed system of obstetric care. The report will present an analysis of texts containing the representation and interpretation by doulas of the practices and approaches of non-medical support for women during pregnancy, childbirth, the onset of motherhood (periods of maximum vulnerability — a radical change in legal and psychophysical statuses). This research is based on field ethnography of Russian perinatal practices and analysis of their representations since 2010 in various contexts and sources (semi-structured in-depth interviews, social networks, media resources, legal acts).

Keywords: non-medical care, individual support of childbirth, doula; partner childbirth, patient vulnerability, informed consent, patient choice, patient rights

DOI:

NAVIGATING INSTITUTIONAL INCONSISTENCIES VIA DIFFERENT EMOTIONAL STYLES: COMMUNICATION IN MATERNITY CARE IN RUSSIA

Anastasia Novkunskaya

Associate professor, Department of Sociology, Institute for Interdisciplinary Health Research, European University at Saint-Petersburg, St. Petersburg, Russia; e-mail: anovkunskaya@eu.spb.ru

Abstract: Over the past decades, the healthcare system in Russia has undergone multiple changes, affecting both its institutional arrangement and the practice of interpersonal interactions. The commercialization of medicine, consumerization of patient behavior, emergence of new medical approaches (Temkina 2016, 2017), and changes in professional standards of care have created complex settings in which social norms and rules turn out to be numerous and sometimes unreliable.

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Despite the volatility of this context, some forms of communication between key participants remain stable and have been in place since the Soviet period. In particular, the "Soviet approach" was recognized as paternalistic (Rivkin-Fish 2005). That is, assuming an asymmetry of power between patients and medical professionals, between the latter and the management of healthcare organization, and between entire health care system and the state ideology (Field 1957; Saks 2015). Thus, social and healthcare reforms carried out since the early 1990s have shaped the context of healthcare institutions in Russia, but the latter remains largely "unfriendly" to patients and reproduces inequality at the level of social structures and everyday communications. This study, based on qualitative semi-structured interviews with health practitioners and patients, as well as on a series of observations in a medical center, addresses the sustainability of the rude and unfriendly forms of. In addition, the study describes some forms of undesirable communication between patients and healthcare practitioners, or between representatives of different professional groups.

Keywords: maternity care, healthcare professionals and organizations, communication in medicine, emotional styles, khamstvo

DOI:

PREPARATION FOR CHILDBIRTH IN THE CONTEXT OF INTENSIVE MOTHERHOOD: BASIC FUNCTIONS

AND PARADIGMS

Anna Ozhiganova

Senior Researcher, Center of Medical Anthropology, Institute of Ethnology and Anthropology of the Russian Academy of Sciences, Moscow, Russia; e-mail: anna-ozhiganova@yandex.ru

Abstract: The practice of teaching pregnant women using specialized courses is becoming increasingly popular due to the widespread ideology of intensive or conscious parenting since the end of the XX century. This training serves many functions e.g., obtaining information, physical training, gender socialization, communication, psychological training, and even the experience of altered states of consciousness. The concept of authoritative knowledge about pregnancy and childbirth proposed by the American anthropologist B. Jordan (1993), analyses the knowledge that is produced and transmitted in preparation for childbirth and characterizes it as a kind of synthesis of the (bio) medical and the alternative. This includes the experienced knowledge of individual (homebirth) midwives. This approach also draws attention to the distribution of authority knowledge depending on the type of relationship between participants - horizontal or hierarchical. This study is based on field materials including interviews with women and trainers, as well as participant observation data from birthing preparation centers and the results of a small online survey conducted in March-April 2022. Different approaches presented in Russian parenting centers are examined and a conclusion is made that there are several basic styles or paradigms of preparation for childbirth, which can be conventionally assigned as radical, neoliberal, traditionalist, and reflexive. The radical version of preparation, which dates back to the ideological paradigm developed among alternative parents in the 1980s and 1990s, uses the rhetoric of a woman's personal responsibility for the outcome of childbirth and does not view pregnant women as patients. The neoliberal paradigm, closely linked to the ideology of intensive motherhood, focuses primarily on the expert knowledge of physicians, but also on the knowledge of professional midwives and birthing leaders. The traditionalist approach appeals to patriarchal family values and gender roles and seeks to recreate an extended family atmosphere and benevolent communication in a "women's circle". The reflexive approach favors psychological and meditative practices; preparation for childbirth is positioned as a creative project of the woman herself, in which she invests important meanings for herself.

Keywords: preparation for childbirth, intensive parenting, authoritative knowledge about pregnancy and childbirth, medicalization of childbirth, responsibility

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