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Meaning and Distinction
Consider the times you have attended a birth that you experienced as lovely while the birthing woman experienced it as disappointing. Recall the woman who has an unplanned cesarean section who tells you it was a wonderful birth experience while you, the provider, are wondering whether you have disappointed your patient by not protecting her from surgical intervention. Think about the woman who is having a calm, pleasant, satisfying experience feeding her baby and watching him grow while you are bemoaning the fact that she is not breastfeeding. Finally, envision a postpartum visit to your client’s home in which you observe an endless stream of visitors, each one holding and caring for the baby while the mother sleeps or busies herself with household tasks. She comments that it is relieving to have so many people involved in the baby’s life while you worry that she is not making a healthy connection with her baby. The scenarios are endless but the few mentioned here illustrate the ways in which the meaning we make of a shared event can differ widely from that of the woman with whom we are working and sharing the experience.
How often do you find yourself saying you hope your patient has an empowering birth experience? How many times have you asked a client if she had a good birth? Did she have a positive interaction with her healthcare provider? Is she having a satisfying or successful breastfeeding experience? Does she feel like she is making progress? Has she grown from her experience? Has she made change? Our questions are well intended. We are sincerely invested in and interested in the woman’s experience. However, in asking these questions, we are taking for granted the existence of a mutual understanding and agreement of terms, values, and goals between ourselves and the women with whom we work. The above mentioned highlighted terms involve emotional reactions and are contextualized within personal systems of meaning- making. There may not be a universal, objective way to assess these internal emotional experiences nor does there need to be.
Instead, our focus must be to bear witness to the woman’s own process of making meaning of her experience. Our task is to facilitate this process for her, to create a safe space in which she can travel to what Robert Kegan refers to as “…the place where the event is privately composed, made sense of, the place where it actually becomes an event for that person. (The Evolving Self, p. 2)” This requires a more open-ended style of inquiry such as “I am curious about what it was like for you?” or “Tell me about your experience.” It necessitates a letting go of our own hopes and expectations for her, leaving behind our preconceived notions of how to process an event, tabling our own agendas, and often withholding our opinions. It means keeping our own issues and reactions in check. Given that our passions often fuel our work, this can be challenging. We are often told to remain objective. The word “objective” can imply emotionless, impersonal or unbiased. Most of us would not qualify as “objective,” especially when it comes to pregnancy, birth, mothers and babies. I offer an alternative; remain aware.
To remain aware, we must be open to our conscious and unconscious processes at work inside of us. We must be willing to examine ourselves on an ongoing basis. As I have said in a previous newsletter, this inner work is part and parcel of self-care; it is our responsibility as care providers and role models. Keep in mind that as we bear witness to our patients’ and clients’ processes of meaning-making, we, too, are making meaning of our experiences with them and their stories. We must remain aware and cognizant, though, to ensure that our meaning remains separate from that of our patients.
“Among the many things from which a practitioner’s clients need protection is the practitioner’s hopes for the client’s future, however benign and sympathetic these hopes may be.” (Robert Kegan, The Evolving Self, p. 296)
I found this quote both provocative and meaningful. Naturally, we have hopes for our clients and patients. We want to help them reach their goals, whatever they may be. We want to provide the kind of services and support they are seeking from us. We want to encourage health and wellbeing. We want to facilitate positive experiences for them. If we abide by Kegan’s notion, we are challenged to find some way to create enough space for our clients to take their journeys, aware of our caring for them and yet unencumbered by our hopes for them, free to create their own process of meaning-making and free to discern their own meaning. Kegan acknowledges that this notion of needing to protect clients or patients from the provider’s hopes may be “…a harsh-sounding thing to say!” However, he also says, “It arises out of a recognition of the other’s distinctness (p. 296).”
Similarities comfort us; differences challenge us. We aim for respect in the face of difference and yet, may secretly harbor hopes for change that brings us closer in line with each other. The word “sisterhood” is often used in relation to groups of women who provide care for other women during the childbearing time. The dictionary defines “sisterhood” as “the solidarity of women based on shared conditions, experiences, or concerns.” There must be room within sisterhood, within and across colleague groups and within the community of humanity at large, for differences in style, beliefs, processes of meaning-making and in meanings themselves. As providers of care and as facilitators of life transitions, it is our obligation to stay ever mindful of differences and gather strength from them, using them to stretch ourselves rather than to limit ourselves and our interactions.
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