Anticipatory discourse in prenatal education

Abstract

This article explores communicative aspects of preparing others, by studying prenatal education classes in which midwives prepare expectant parents for delivery. Data include documentation from classes and interviews with the presenters. This twofold dataset enables investigation into how ideologies of communication figure into the production of discourse. A dominant idea is that discourse can stand in for lived experience in the endeavor to decrease nervousness and fear in the expectant parents. The observation data are therefore analyzed by paying attention to how the expectant parents’ future deliveries are discursively represented. Drawing on the conceptual framework for analyzing anticipatory discourse, the study shows how the midwives largely frame this future as predictable and the mother as highly agentive. When addressing unexpected turbulence, however, the midwives use the opportunity to stress the agency of medical professionals to maintain a representation of the delivery event as generally predictable.

Keywords

Anticipatory discourse childbirth health communication ideologies of communication language ideology parental education preparation

Introduction

Preparing others for an event that is unfamiliar to them but lies ahead in their future is obviously a common pedagogic endeavor. In fact, it is situated at the heart of most educational practices (De Saint-Georges, 2012). Communicative acts of preparing others involve various forms of what Scollon and Scollon (2000) call anticipatory discourse, that is, language used for attempts to predict and shape the future. This phenomenon is particularly tangible in prenatal education that prepares first-time parents for delivery. While health communication often involves various attempts to discursively prepare the caretaker for upcoming events, there are some significant aspects that differentiate hospital childbirth from other events in similar settings. First of all, childbirth does not in any crucial way attempt to correct a pathological condition, as would be the case for surgery and many medical examinations. Second, when it comes to vaginal childbirth – which is the prototypical case drawn on in the prenatal education classes examined in this study – the caretaker is highly agentive in the actual event, being as she is involved in processes such as going through contractions and pushing, as opposed to patients in surgery who may even be asleep or are at least expected to lie completely still while the medical experts perform their actions. Third, and related to the latter, during vaginal childbirth, the caretaker is expected to express ad hoc dictations regarding some of the conditions of the event, involving how she wants to be positioned and what forms of pain relief she wants to use. All in all, birth givers, in contrast to many other caretakers, have to be prepared to act and make decisions during the event.

This article focuses on prenatal education in Sweden. Here, public health services offer all expectant parents free prenatal education, an offer taken up by roughly 90% of individuals expecting their first child (Fabian et al., 2004). At stake is the act of preparing expectant parents for parenthood in general and the upcoming delivery in particular. The intended communicative function of preparing parents for delivery is the focus of this article. Following Scollon and Scollon’s (2000) framework for analyzing anticipatory discourse, it investigates ways in which midwives discursively represent the future deliveries of the participants, with particular attention being paid to stances taken toward the predictability of future events and the extent of the agency of the involved social actors to influence those events. In detail, it does so by looking into the ways in which midwives account for actions and events that will, may or should occur during the participants’ future deliveries. Here, video data from two classes of prenatal education are analyzed in terms of content as well as form. Additionally, in order to grasp the relationship between the concrete discourse – the actual language in use – and its intended function, the study also draws on interview data with the midwives leading the classes, with particular focus being on the ideologies of communication (Briggs, 2005) that mediate the production of this preparatory discourse. With this double-faceted approach, the article aims to grasp the discourse under study as a total linguistic fact (Silverstein, 1985), by taking seriously the dialectic nature of language as constituted in the relations among linguistic forms, situated usage and cultural ideology.

Communication and the future

As Bourdieu (1977) has proposed, our life histories tend to endow us with a sense of knowing how to behave in certain situations. In regard to situations with only weak links to our previous experiences, therefore, we tend to be troubled by a sense of not knowing what to do, a sense that can be discomforting, but also intimidating in some cases – the first-time experience of childbirth arguably being one of the latter. A relief from this frightening potential of unfamiliar experiences is imagined by Douglas (1973: 71), who (in passing) points to the possibility of a use of language that is ‘extended between the hence and the ago’, that can potentially transcend the lived experience. This capacity in language has been identified from various perspectives. Ochs (1994) analyzes the ways in which narratives of personal experience hold the ‘capacity to extend the past into the present’ (p. 108), thereby rendering the past eligible to use as a resource to understand the present.

Talk about the future is also common in medical settings. Robinson and Stivers (2001) describe how physicians draw on verbal as well as nonverbal communication to accomplish transitions into physical examinations and thus reduce patients’ uncertainty. Similarly, Gilstad (2012) shows how midwives use careful metacommentary when they prepare and perform ultrasound examinations on pregnant women who are ostensibly anxious about this technology. Dealing with more long-reaching perspectives on the future, Peräkylä (1993) studies the way in which AIDS counselors talk to HIV positive individuals about potential hardships in their future, and points to the way in which such conversations need to invoke the hypothesis of a ‘hostile world’ of undesired circumstances so as to be able to prepare the patients for what they may experience. By a similar token, Sarangi (2002) examines stances of probability and certainty in genetic counseling, and shows how clients and counselors deal with probabilistic statements that are used to formulate imaginable futures to prepare for, negotiate and relate to. Looking at communicative practices connected to childhood cancer treatment, Clemente (2015) shows how doctors and parents adopt various communicative strategies to avoid letting the uncertainties related to cancer become the central focus of talk and social life. Of particular interest to the present article is Bredmar’s (1999; see also Bredmar and Linell, 1999) work on consultations between midwives and expectant mothers within Swedish maternal healthcare, demonstrating how matters pertaining to risk, anxiety and normality are negotiated as part of the interaction. The present article furthers this focus by studying midwives who, in the particular communicative setting of prenatal education, attempt to prepare expectant parents for their deliveries.

Anticipatory discourse

Discourse about the future is frequently used in communicative attempts to manipulate how the future unfolds. The notion of anticipatory discourse (Scollon and Scollon, 2000) offers a way of analyzing linguistically how this is attempted, thereby exploring not only the referential dimension of language, but also the performative functions inherent in communication more generally (De Saint-Georges, 2012: 5). The Scollons suggest that accounts of the future be analyzed with attention to how these accounts take stances toward the predictability of future events, as well as to the extent of the agency of involved social actors to shape the way in which these events unfold (Scollon, 2008; Scollon and Scollon, 2000).¹ Predictability stances may range from rendering the future completely predictable to rendering it impossible to know anything about it. Regarding agency, in turn, the extreme at one end renders social actors completely incapable of influencing the future (be it known or unknown), while at the other end social actors are imagined as fully capable of designing their own future. This conceptual framework has been quite scarcely employed and elaborated, although it is well grounded in Scollon and Scollon’s more general conceptual framework (Scollon, 2008; Scollon and Scollon, 2004). The Scollons use the notion of anticipatory discourse to critically analyze ideological representations of the future, such as the neoliberal trope that individuals are free to be whatever they want to be (Scollon and Scollon, 2000) or predictions of the consequences of political decisions (Scollon, 2008). Also in the ideological domain, Jaworski and Fitzgerald (2008) draw on the notion of anticipatory discourse to explore how politicians tend towards the predictability and controllability of the future in election campaigns. On a more microscopic level, this framework can also illuminate analyses of individuals’ strategic use of future-oriented narratives to persuade interlocutors to act in a certain way (Al Zidjaly, 2006). Furthermore, longitudinal datasets have been used to study the anticipation of futures along with accounts of the actual course of events, thus allowing for an analysis of how discourse has actually influenced the future (De Saint-Georges, 2005).

This article offers further input into the discussion of the functions of communication by bringing onboard metadiscursive issues of the ways in which producers of anticipatory discourse reflect on possible or intended functions of the ways in which they communicate with others about the future. Following Briggs (2013: 288) in the supposition that ‘people construct cultural or ideological models of circulation at the same time that they engage in complex circulatory practices’, the data are therefore analyzed with attention to ideologies of communication. Originating out of the work on language ideologies as a field of inquiry (Schieffelin et al., 1998), ideologies of communication can be defined as ‘socially situated constructions of communicative processes – ways in which people imagine the production, circulation, and reception of discourse’ (Briggs, 2007: 556). To talk about ideologies of communication is to recognize that social agents carry within them systems of ideas about how communication functions. Accordingly, the midwives’ metadiscursive reflections, derived mainly through interviews, are here seen as important insights into the study of how they use communicative practices to prepare others for action yet to come.

Dataset and methodology

The article draws on data from two prenatal education classes in Stockholm, in fall 2014, led by midwives Anita and Sara,² respectively. Both classes were advertised as preparation for delivery and parenthood. Each class was given in two 3-hour sessions with 1 week in-between (13 hours in total). In the interviews conducted with each midwife after one of her sessions, the informants were invited to reflect upon the communicative practice of giving these classes as a way of preparing expectant parents for delivery. The main data derived from the study are video recordings of the classes and audio recordings of the interviews. Additional data are field notes, photographs, and online material pertaining to the classes, as well as a print version of the slideshow and a manuscript from Sara’s class.

Anita’s class consisted of 12 participants, all either pregnant women or expectant fathers, who introduced themselves in a round of presentations. In contrast, Sara’s class was a large lecture with 94 participants, of which most remained anonymous while a few had more salient roles. The overwhelming majority of Swedish healthcare, including maternity care and childbirth, is publicly funded. Thus, both classes that were studied were given as a part of the maternity care at the publicly funded maternity clinics where the participants were enrolled.

Analyzing the interview data in relation to the lecture data here serves to clarify more specifically what the midwives attempt to achieve in the classes, and how they go about doing that. As Briggs (2011b: 218) suggests, in order to understand processes of communication, it is fruitful to not only observe communicative practices but also to ‘see how different participants culturally construct the game in which they see themselves as playing’. What the midwives say about the communicative practice of prenatal education suggests how they are able to rationalize the way in which they design their classes. Thus, while it would be misleading to assume that the classes are entirely molded upon concretely formulated ideas about how communication works, the interview data do provide insights into the ideas about communication that the midwives tend towards in order to explain their conduct.

Pace Briggs and his enlightening work on communicability (Briggs, 2005, 2011a; Briggs and Hallin, 2016), the aim here is not to conduct critical analyses of the midwives’ ideologies of communication, in order, for example, to expose potentially oversimplified ideas about communication processes and roles (see also Agha, 2011). The interview data are instead drawn on to analyze what kind of conceptions of communication become fruitful for the midwives as they attempt to understand and explain their practice in interaction with myself as an interviewer. Furthermore, this article will not dwell on the actual uptake of this communication; therefore, data do not include interviews with participants or other expectant parents (for a study that focuses on the uptake of parental health communication, see Hanell, 2017). Rather, the article uses these instances of prenatal education to reach a deeper understanding of how communication can be used to express anticipation of upcoming events and thus attempt to prepare interlocutors for the future.

Anticipating future delivery

The existential pivot constituting childbirth is, to many, an event awaited with both joy and fear. The two midwives included in this study both state that many first-time expectant parents – pregnant women as well as their partners – appear intimidated by the event of delivery, linked as it is to prospects of loss of control and extraordinary pain. The midwives therefore attempt to use the prenatal education classes to decrease this fear and endow expectant parents with confidence and comfort before the upcoming delivery. The following analysis explores the lecture data as well as the interview data to grasp how this communicative effect can be achieved.

The imagined power of discursive encounters

A large share of what the midwives say and do not say during their classes seems to be guided by ideas about what it means to have encountered events and practices discursively when later experiencing them physically. A prominent idea expressed during the classes as well as in the interviews is that it is possible to mitigate the frightening power of the unknown by presenting expectant parents with discursive representations of what they are about to experience. This is evident in the following account by Sara:

Extract 1: ‘I have been here before’. Interview, Sara.³

I think this is the case too: anything you’ve met before isn’t as scary. Because they’re quite vulnerable. When they give birth, it’s like ‘Ouh, what, are you putting an electrode on the baby’s head, what’s that? Oh right, she mentioned that, didn’t she, that it’s quite common that they do that to get a good sense of the baby’s heart rate. Oh right’. […] Just the fact that there is something like ‘Oh right, it was this’. Then I think, then that creates some kind of ‘I have been here before’.

Jag tror så här också: allting som man har stött på tidigare är inte så läskigt. För de är ganska sårbara. När de föder barn, då är det så här ‘Ouh, vadå, ska ni sätta en elektrod på barnets huvud, vad är det? Ja just det, det nämnde hon ja, det är ganska vanligt att man gör så för att få in bra hjärtljud. Ja just det’. […] Bara att det finns någon sån här ‘Just det, det var det här’. Då känner jag, då skapar det någon form av ‘Jag har varit här förut’.

An essential communicative function imagined by Sara here is that discursive representations of a particular kind of event can endow interlocutors with a form of experience of situations they have not really been in. In the observation data, such an idea is manifested in discursive instances where the midwife informs those expecting a baby of things that might occur during delivery. For example, Anita mentions in her class that it sometimes happens that the placenta does not detach from the uterine wall after the baby is born, as it normally should, and it may then have to be surgically removed. ‘This is not very common’, Anita reassures the parents, ‘but just so you’ve heard that.’ Thus, the mere fact that the parents have heard about this risk – that is, encountered it in discourse – can imaginably serve to diminish the potential trauma if this situation were to arise in the medias res of the delivery. It is notable that communication potentially involving the exact same participants – a midwife and expectant parents – would be practically possible during the delivery too. One might therefore wonder why the midwife does not wait until the eventuality that such a situation arises to explain what is happening and that the medical team has a procedure to take care of the situation. Noting this, the intended function of this information does not seem to be that parents should be able to interpret events independently during the delivery – on the contrary, it is likely that they will have this information repeated to them should the situation arise. Rather, the intended effect of informing the parents of the possibility that they will encounter this problem seems to be to mitigate the prospective fright of a potential first-time physical experience.

Consequently, both Sara and Anita spend a fair share of their classes talking about particular details even when they are unlikely to be relevant to most participants. Not all of these details pertain to potentially distressing aspects of the delivery. In the interview, Sara herself brings up the topic of giving detailed information, and then discusses this in relation to talk about methods for pain relief. As it is up to the birth-giving mother to choose pain relief methods that she feels comfortable with, both Sara and Anita thoroughly go through a wide selection of methods from which the mothers can choose. While several methods are named and presented, this does not seem to be intended for teaching expectant parents to master this knowledge independently. This is indicated in the following account by Sara:

Extract 2: Detailed information. Interview, Sara.

I’m not aiming for a situation where they are able to say by rote that ‘I’m having a paracervical block when I come in’ but, you know, to have some idea about everything. To know that there is pain relief, there are these resources.

Jag är inte ute efter att folk ska kunna rabbla att ‘jag ska ha en paracervicalblockad när jag kommer in’ utan alltså att ha ett hum om allt. Att veta att det finns smärtlindring, det finns de här resurserna.

Distinctive terms for various pain relief methods, such as a paracervical block, will ultimately occur in the delivery ward, and to mention these details in advance during prenatal education classes thus serves to provide the possibility for the expectant parents to recognize these details as familiar, thus endowing them with the sense that they ‘have some idea about’ the pain relief methods that are being offered to them on the delivery ward. The fact that the choice of pain relief method is offered to birth givers is interesting in relation to Scollon and Scollon’s framework for anticipatory discourse. To prepare the expectant mother to choose pain relief methods is to prepare her to engage in discourse that puts her in control over an aspect of the way in which the delivery unfolds. While, as both Sara and Anita stress in their classes, there is no way of completely escaping the pain connected to childbirth, the mothers’ high degree of agency in the choice of pain-relief methods is a way of performing control over the pain itself.

The fright of the vaguely known

At the same time that the discursive representations of potentially intimidating events are imagined to be calming, they are imagined as having the opposite effect in some cases. Sara explains in the interview that she avoids talking about brain damage in babies, arguing that such a topic demands lengthy explanations and it is not possible to simply mention the subject and then move on. This assumption rests upon an idea of how her interlocutors deal with the discursive representations she offers in her class; Sara asserts that even if she frames it as statistically highly unlikely that a single infant will suffer brain damage, the very mention of this topic gives members of the audience fantasies, as it were, that their baby is vulnerable to it.

In some cases, such fantasies generated by swift discursive encounters can be handled during class. This goes for many of the medical instruments commonly used during deliveries. Anita explains in the interview that her impression is that many instruments used on delivery wards – vacuum extractors, catheters, scalp electrodes – ‘sound’ scary to expectant parents. Thus, discursive representations of these instruments are thought to cause interlocutors to imagine what these instruments might look like and how it might feel to have them applied. However, these are objects that the parents are likely to encounter physically during the delivery, as well as discursively in various forms of discourse about the delivery. As Anita further elaborates, one way of reducing the fear that these instruments might produce is to not only talk about them but to show them as well. In Extract 3, she focuses on why she often shows a vacuum extractor in class:

Extract 3: Showing the vacuum extractor. Interview, Anita.

Many are really scared to have a vacuum-assisted delivery. They think it [a vacuum extractor] is one of those plunger things that you, like that, but when I show them this extractor I want to reassure many of them that it isn’t, it doesn’t look that bad. Yeah, that you see what it’s about, because a vacuum extractor, to many people that sounds awful. While when you get to see the thing, it’s not as dramatic.

Många är jätterädda för att bli förlösta med sugklocka. De tror ju att det är en stor avloppsvariant som man, så, men när jag visar den här klockan så vill jag ju lugna ner många med att det är inte, den ser ju inte så farlig ut. Men att man ser vad det handlar om, för en sugklocka i mångas öron det låter ju förfärligt. Medan när man får se på saken så är det inte lika dramatiskt.

Here, the tension plays out between two modalities through which the event of using this instrument are represented (cf. Iedema, 2003). As talk about the vacuum extractor potentially ‘sounds awful’, encountering material representations of it may be less frightening to expectant parents, as ‘when you get to see the thing, it’s not as dramatic’. In accordance with this assumption, both Anita and Sara present several medical instruments in class. The next section analyzes one such presentation in detail.

Potentially frightening topics

A medical instrument that Sara introduces is a scalp electrode, a device used for monitoring the fetus’ heart rate during labor. Following a pattern that has appeared in similar cases in the data, what Sara does to introduce this instrument is construct a narrative of a critical situation where the instrument in focus serves as a means of taking control and maximizing safety. Showing a photograph of a cardiotocography (CTG) machine in her slideshow presentation, Sara first explains that the baby’s heart rate is monitored during labor, and that this is usually done with external devices fastened on the mother’s stomach. However, the external devices can sometimes incidentally pick up the mother’s heartbeat instead, which is typically much slower than the baby’s. In such cases, the midwife needs to ensure that it is not the baby’s heart rate that is so slow, and here is where she might decide to put on a scalp electrode. The narrative produced here, seen in Extract 4, is cast with Sara herself as the protagonist, acting as a midwife in the potentially turbulent delivery situation:

Extract 4: Scalp electrode. Lecture, Sara.

Then I get a heart rate somewhere between about fifty and eighty. Then I might assume ‘This is mom’s pulse’. But I can’t assume that for 50 minutes, because if it were the baby’s heart rate then I get a very tired and exhausted baby. And so I go on fiddling with these devices and eventually you go completely crazy because you don’t know what’s what and I need to be sure what it is. And then I put on a scalp electrode. [Clicks to show a scalp electrode on her slideshow.] And a scalp electrode is like a little antenna. It looks like this before it’s completely into place. Like a little antenna that you put on the baby’s head. Now that might sound really scary. You attach it to the skin creases. It’s really cramped to be born. This does not end up in the brain, it doesn’t end up anywhere, it ends up in the utmost skin creases of the baby.

Då får jag in hjärtslag på någonstans mellan femtio och åttio ungefär. Då kan jag ana ‘Det här är mammas puls’. Men jag kan inte ana det i 50 minuter, för skulle det vara bebisens hjärtljud då får jag ut en väldigt trött och tagen bebis. Och så håller jag på och donar med de där dosorna, och till slut får man bara spunk för man vet inte vad som är vad, och jag måste ha på fötterna vad det är. Och då sätter jag skalpelektrod. [Klickar fram bild på en skalpelektrod i bildspelet] Och en skalpelektrod är som en liten antenn. Den ser ut så här innan den är helt på plats. Som en liten antenn man sätter på bebisens huvud. Det kan ju låta jätteläskigt. Man skruvar fast den i hudskrynklet. Det är jättetrångt att födas. Det här hamnar inte i hjärnan, det hamnar inte någonstans, det hamnar i yttersta hudskrynklet på bebisen.

Extract 4 shows the first introduction of the scalp electrode in Sara’s class. Interestingly, the acknowledgment that it ‘might sound really scary’ is here juxtaposed with the previously expressed conflicting threat that the baby may have too slow a heart rate. While this threat is accepted as valid, as if true it would result in the birth of a ‘very tired and exhausted baby’, Sara asserts that there is no reason to fear the actual scalp electrode. She thereby contradicts the suspicions that the audience might have concerning the risks of using a scalp electrode with what is framed as an evident risk, related to running short of the heart rate data that the scalp electrode can assist her in producing. This background is chronologically narrated around simple time adverbials, which are employed to introduce new circumstances, Sara’s interpretations of them, and her consequential actions: ‘Then I get’, ‘Then I might assume’, ‘And so I go on fiddling’ and, as a consequential solution, ‘then I put on a scalp electrode’. In this manner, the background narrative culminates with the midwife’s action of installing the scalp electrode. Simultaneously to mentioning this instrument, Sara clicks on her slideshow presentation to show a large picture of a scalp electrode, and some 40 seconds later she also brings out a physical scalp electrode and holds it up to the audience (after the end of the extract).

Figure 1 shows Sara with a scalp electrode in her hand and the photograph in the slideshow behind her. This goes to show that Sara uses discursive as well as material and visual representations to introduce the expectant parents to the potentially ‘scary’ event of having a scalp electrode inserted. Note that it is because of this narrative that Sara speculates in the interview, as shown in Extract 1, that the parents will have a sense that they ‘have been here before’ if they happen to be introduced to a scalp electrode during their delivery.

Figure 1.

Left: The scalp electrode shown in Sara’s class; author’s photograph. Right: Sara showing the scalp electrode, with the slideshow photograph behind her; author’s film still (cropped).

Ochs (1994) has shown that even if narratives are prone to be recognized as a discursive mode for recollecting the past, they are also commonly used to relate to the future. This is evident in the anticipatory discourse of Sara’s account about the scalp electrode. The future narrative that Sara produces here deals with an ambiguous prognosis, constituted by the uncertainty of the origin of the slow heart rate data. In this narrative, as we have seen, the midwife takes control over the situation by putting on a scalp electrode. Viewing this through the lens of analyzing anticipatory discourse, it is clear that Sara here is deploying the possibility to emphasize her agency to compensate for the sense of lacking control that the uncertain future might generate. In short, what this common trope proposes is that while it is not possible to know what will happen during the delivery, the midwife is ready to act and thereby control the outcome of any situation that might arise (cf. Scollon, 2008: 137). Therefore, what might have been a frightening narrative of a potential delivery event points, on the contrary, to a space for the midwife’s agency to be played out, thus rather indicating that even though there are risks related to childbirth, there is no need to be afraid as long as professional caregivers are involved. This trope is further emphasized as Sara goes on with her narrative after she has described how the scalp electrode is inserted. This is seen in Extract 5:

Extract 5: Slow heart rate. Lecture, Sara.

… and then you connect it to the CTG machine. And then I see: ‘Aha. 152. The baby’s heart rate. Great.’ Should it still be on 60, then I know that that’s the baby’s heart rate at 60. Then we must act now. And we have all the resources for that. We can get a baby out in [snaps fingers] you won’t have time to blink before the baby’s out.

… och sen kopplar man den till CTG-apparaten. Och då ser jag ‘Aha. 152. Bebisens hjärtljud. Jättebra’. Skulle det fortfarande ligga på 60, då vet jag att det är barnets hjärtljud på 60. Då måste vi agera nu. Och det har vi alla resurser för. Vi kan få ut en bebis på [knäpper med fingrarna] ni hinner inte ens blinka så är bebisen ute.

Here, the narrative encompasses an imaginable future of a definite signal of a slow heart rate. In this particularly frightening scenario, Sara again steps forward in a highly agentive role. Grammatically, the verb should (Swe: skulle) here effectuates a temporal shift with a modal meaning, rendering the proposition hypothetical. Thus, Sara maintains that the scenario is improbable, while still being able to state that if it should occur, the medical staff has the capability to avert the further unfolding of events by bringing the baby out remarkably quickly. Meanwhile, the non-professional participants in childbirth are not ascribed any agency at all in this account. The baby is a mere sender of signals to the CTG machine, and the mother is a container of this sender; no partner is mentioned whatsoever. Thus, this account of turbulence during delivery is given a highly techno-medical frame where the parents’ non-agency frees them of all responsibility for how the course of the event develops.

Semiotizing sensations

For Anita, one rationale for describing future labor events in detail is that parents might find it easier to cope if they know in further detail what it is that happens biologically during labor. This is expressed in Extract 6:

Extract 6: Bodily processes pertaining to childbirth. Interview, Anita.

Delivery to many people I think that’s just one single pain and that the head comes, that the baby comes out. But they don’t know what it is that hurts or why it takes so long. I hope they understand what it is that happens by means of, that the pelvis actually needs to expand and that the baby is supposed to get out slowly but steadily.

Förlossning för många, det tror jag bara är en enda smärta och att huvudet kommer, att bebisen kommer ut. Men de vet inte vad det är som gör ont eller varför tar det så lång tid. Jag hoppas att de förstår vad det är som händer med hjälp av, att bäckenet faktiskt måste utvidgas och att barnet ska ut sakta men säkert.

What Anita says here is predicated on the assumption of an important function in communication. As evident, Anita reckons that the sensation of overwhelming pain typically associated with childbirth may be experienced as more endurable by means of knowledge about its cause. This ‘knowledge’, as Foucault (1973) has clearly shown, is a product of the discursive process of rendering bodies legible and thus intelligible. Both classes include explications of biological processes that generate the sensations internally experienced by the woman and externally witnessed by her partner during labor. Such a demystifying process involves entextualizations (Bauman and Briggs, 1990), that is, the process of turning events and experiences into discourse with text-like properties. However, visual and material representations are also important in this process of concretizing the abstract by introducing it into the realm of semiosis; as such, the word semiotization may be a more suitable label for this process (cf. Iedema, 2003). This semiotization includes discourse and forms of medical imaging (Jones, 2013) intended for using during the delivery to grasp and endure what may feel like one single excruciating pain. One method of medical imaging used in both classes is to paint typical graphs of contractions on a whiteboard (faintly indicated to the left in the picture of Sara in Figure 1). This painting, similar to the graphs produced by CTG machines, projects a tangible visualization of internally sensed labor pains and dissects them into distinct contractions where the graph line reaches a peak, followed by pauses in which the graph line sinks to a minimum.

An instance in which Anita pursues the endeavor of semiotizing sensations is when she goes through the pushing stage of labor. This is a part of a chronological narrative of the delivery, and Anita has signaled the introduction of a new stage by saying, ‘And then it’s time to push’. During this account, she uses a doll and a model of a pelvis (Figure 2) to demonstrate the fetus’ way through the birth canal, and she also uses her own hands to represent the orifice of the uterus gradually opening as the baby’s head pushes through.

Figure 2.

Left: Model of a pelvis used in Anita’s class; author’s photograph. Right: Anita demonstrating the expulsion with the use of a doll and the pelvis model; author’s film still (cropped).

Anita describes the general outline of how the delivery will progress, explaining how the woman will feel the baby coming through in a back-and-forth manner and descend through the birth canal between contractions. With Scollon and Scollon (2000), it is notable that every event of this stage is narrated as completely predictable, while the woman is maximally agentive and in full control of how the pushing stage proceeds. As the baby passes a certain point in the birth canal, it will not descend anymore. Having established earlier in the account of the pushing stage that ‘All of you are terrified that you’ll get too damaged, to be sure’,⁴ Anita explains that this last step of the expulsion is deliberately prolonged to minimize the risk of vaginal tearing, a precaution potentially conflicting with the fact that this step tends to be connected to a burning pain. Notably, Anita here abandons the focus on the sensations and actions of the mother to instead explain the medical rationale for the midwife’s procedures during the last steps of this stage. This is seen in Extract 7:

Extract 7: Burning. Lecture, Anita.

Because here is this little baby and it burns. And then one says like ‘Oh my, now it’s only a couple of contractions to go and then your baby is here’. Because you have to think like this: ‘Oh my, it’s so good that it’s burning because it’s coming soon now’, that’s what you have to think when it’s like this, at its worst. And then one lets it forth maybe a little bit more so that the head is positioned like this. And this is done for your sake, so that everything kind of, com-, slo-, so it doesn’t get too, if the head comes out too quickly, well the risk is that you tear, alright. So this is done for your sake.

För där står den här lilla bebisen och bränner. Och då säger man så här ‘Men gud nu är det bara några värkar kvar och sen kommer eran bebis’. För tänk så här: ‘Men gud vad bra att det brinner för snart kommer den’ får ni tänka då när det är så här som värst. Och sen så släpper man fram kanske litegrann till så att huvudet står så här. Och det här gör man för eran skull, för att inte ni ska gå sönder. För här får underlivet tänja, sakta men säkert, så att allt liksom, kom-, sakt-, så att det inte blir för, kommer huvudet ut för fort, ja då är det risken att man brister dårå. Så det här gör man för eran skull.

The issue dealt with here is apparently one that Anita considers to be delicate, as she interrupts and reformulates herself several times when addressing the risk of vaginal tearing connected to this stage in labor. Provided that this issue is supposedly distressing to many in the audience, Anita ventures to present the expulsion as it is seen from the perspective of medical professionals. Having previously included the sensations and actions of the mother in the descriptions of contractions, pushing, and the initiation into expulsion, Anita here adopts the perspective of the midwife. A generic midwife is assigned an encouraging line directed to the generic parents in the narrative. Pointing to the connection between the accumulation of burning pain and the progress of the expulsion, Anita furthermore recommends to the audience a voiced affirmative thought in which to engage when they find themselves at this point of the delivery, in order to cope with the unprecedented physical sensation and avoid an uncontrolled surrender to despair when the pain is ‘at its worst’. Accounting for this stage from the perspective of the medical gaze allows Anita to frame the stage and its related burning pain as something that is ‘done’ by the medical staff in order to secure a safe expulsion for the mother. Strikingly, while the prospect of pain may be distressing to many in the audience, Extract 7 shows how Anita presents the pain as a choice made on the basis of medical knowledge to subject the woman to this sensation, thus framing the event as amenable to human agency by significantly downplaying those aspects that are beyond the actors’ control.

Concluding remarks

This article has sought to account for discourse produced by midwives with the aim of preparing expectant parents for their upcoming deliveries. The notion of anticipatory discourse (Scollon and Scollon, 2000) has directed the analysis toward how the midwives’ discursive representations of the upcoming delivery involve stances regarding how predictable this future is, as well as regarding the extent to which social actors – parents and medical staff – have the agency to influence this future. Attention to these two factors reveals that the midwives tend to frame the delivery as relatively predictable, by describing with very little hedging how the participating parents will experience their delivery, and by describing expected physical sensations as well as emotions. While the midwives acknowledge that many aspects of the delivery are beyond the control of human agency, what they expand upon in their classes are the small ways in which participants such as the mother, the other expectant parent and the midwife can affect how the future events unfold. Stressing the room for agency opens up a space for mitigating the distressing sense of lacking control commonly felt by expectant first-time parents. Talk about the agency of the parents at least partly serves to prepare them to act in ways that ensure the delivery will go as smoothly as possible. To expand upon the agency of medical professionals, however, rather appears to function as a way of signaling to the parents that even if the course of events is not completely predictable, the medical team has the power to steer the development back into the right direction. Perhaps self-explanatorily, even the narratives in the data that deal with turbulent delivery events always end positively, not seldom, thanks to the strong agency of a midwife or other medical professionals.

The analysis points to the fact that individuals who produce discourse aimed at preparing others do this in relation to ideas about how communication works, here referred to as ideologies of communication. While the relation between ideologies of communication and the concrete discourse that is produced remains an under-explored topic, this twofold analytical set has given rewarding insight into how meanings are construed and circulated in discourse. With the dual focus on discourse in practice (the lecture data) and on metadiscursive reflections by the producers of that discourse (the interview data), the article has shed light on the communicative functions in play in acts of preparing others. This way, the analysis of linguistic forms in situated use has been related to ideologies of communication that have mediated the production of this discourse. Thus, adhering to what Silverstein (1985) calls the total linguistic fact, this article seeks to avoid the pitfall spotlighted by Rampton (2013: 377), that is, that neglecting any of the aspects of the total linguistic fact constitutes a risk of falling back on common-sense assumptions in order to fill the gap left by the failure to investigate it empirically.

A dominant idea in the metadiscourse of both midwives is that discourse can, to some extent, deputize for lived experience. The idea is that a first-time experience of a distressing event, such as having a scalp electrode inserted during labor, can be less distressing if it is preceded by a previous discursive encounter of the event. This explains why the classes include several quite detailed accounts of not only what tends to happen during deliveries, but also what might happen, even if unlikely.

Furthermore, both midwives seem oriented by the conception that meaning is an emergent phenomenon that is partly produced by the listener. The consequence of this is that the midwives see the need for closer explanations of issues that are discursively introduced during the class, or that the expectant parents are likely to encounter otherwise. Discourse denoting a particular medical instrument, such as a vacuum extractor, is imagined to produce only partly valid ideas in parents about the nature of this instrument. The midwives thus draw on multiple modalities, such as narratives, photographs, material representations and dramatizations to further introduce the participants to events and artifacts which on first encounter may unjustly appear daunting.

Finally, a supposition that appears foundational to the very concept of talking to expectant parents about childbirth is that distressing experiences that cannot be avoided may nevertheless be experienced as more endurable to an individual who has knowledge of what it is that happens and why it is necessary. In this logic, the midwives deal with the topic of inevitable labor pains by explaining the biological process of birth at various phases and stages. Again using multiple modalities, they bring physical and emotional sensations into semiosis, thereby offering them to the expectant parents as something palpable, graspable and, consequentially, negotiable.

All in all, it does seem clear that, as Grossberg (1982: 86) postulates, ‘signs are the means by which we escape the solipsistic subjectivity of meaning’, ergo, that through discourse and other forms of signs in use, we can know of things outside of our own lived experience. However, as Grossberg continues to argue, it is not as clear how this function arises in discourse. As this article has shown, the notion of anticipatory discourse brings clarity to this issue. The article has drawn on this notion to analyze a communicative practice in which midwives attempt to prepare expectant parents for their future deliveries. Connecting a close analysis of discourse in practice with the presenters’ metadiscursive reflections about this discourse has allowed this article to explore fine nuances in discourse deliberately designed to overcome well-known effects constituted by lack of lived experience.

Footnotes

Acknowledgements

My appreciation goes to Anders Björkvall, Mona Blåsjö, Maria Bylin, Rodney Jones, David Karlander, Caroline Kerfoot, Maria Rydell and Linus Salö for reading and commenting on this work at various stages. I am furthermore grateful to the midwives who agreed to take part in the study, and to the forum writers on who helped me with some of the medical details related to the data.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Notes

Author biography

Linnea Hanell holds a PhD in Scandinavian languages. She mainly works with sociolinguistic and linguistic-anthropological aspects of communicating knowledge about health. The present study is a part of her doctoral dissertation The Knowledgeable Parent (Stockholm University, 2017), which deals with the communication of health knowledge among new parents in Sweden.

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