‘I am becoming a mother’ –
Practices of doing motherhood in the first six
months after childbirth in contemporary Dutch
society
Madeleine Herzog
madeleine_herzog24@web.de
10862234
Msc Thesis
Cultural and Social Anthropology
Supervisor: Dr. Trudie Gerrits
Second Reader: Dr. Kristine Krause
Third reader: Anja Hiddinga
21.06.2015
38.707 words"Declaration: I have read and understood the University of Amsterdam
plagiarism
policy
[published
on
http://www.student.uva.nl/fraude-plagiaat/voorkomen.cfm]. I declare that this assignment is entirely my own
work, all sources have been properly acknowledged, and that I have not
previously submitted this work, or any version of it, for assessment in any
other paper."
Table of Content
Acknowledgements
1
Abstract
2
1. Introdcution
3
Context of this research
5
1.1. Theoretical background
9
New Kinship Studies
9
Doing Kinship
10
Feeling of relatedness
12
1.2. Methodology
12
Study Design
13
Selection of interlocutors
14
Reflection on my role as a researcher
15
Outline of the thesis
16
2. Becoming a mother: a rite de passage
18
Withdrawal and preparation for motherhood
22
Transition Phase
23
Re-integration into society
27
2.1. Becoming a mother: challenges and difficulties
29
Pain, breastfeeding and sleep deprivation
30
Baby Blues
32
Getting to know the baby & adapting to its needs
33
Work life
36
From being a couple to shared parenthood
38
Changes in relationships
40
Discussion
41
3. Practices of doing motherhood
43
Notions of kinship
46
Breastfeeding
48
Cuddling/ Washing
58
Discussion
62
4. Practices of doing motherhood: support
65
Grandmothers
70
Kraamzorg
77
Pre- and postnatal groups
81
Babysitters
84
Discussion
87
1
Acknowledgements
A great pleasure of finishing this piece of writing is to thank people who
supported me and who made this thesis possible. First of all I want to thank
all of my interlocutors for sharing their stories, for opening their homes and
hearts for me and for making this research unforgettable. Trudie, I am very
grateful for your support as my supervisor. In every situation you found the
right words to keep me going, your criticism was always constructive and
your advice more than helpful. I could not have had a better, more
understanding and lovely supervisor who made me feel so comfortable
during the whole process of researching and writing this thesis- heel erg
bedankt! I also want to thank all the teachers who supported me on my way
so far, I have learned a lot from each of you. Last but not least I want to
thank my family and my lovely friends. Without you carrying out practices
of doing family and doing friendship I would not be the person I am now
and this thesis would have never been possible. Thank you!
2
Abstract
Van Gennep’s theory of rites des passage addresses childbirth as a major life-event which is ritually marked in order to facilitate the transition into the new life stage of parenthood. This research shows how Dutch, high-educated, first-time mothers experience the transition to motherhood and in what ways these new mothers carry out practices of doing motherhood – a term based on the New Kinship scholar’s understanding of socially constructed kinship – in order to facilitate the performing of the maternal role. A further focus is put on different kinds of support which is provided for Dutch mothers in the postpartum period beneficial to deal with this transition process.
This study was conducted from January till March 2015. The setting of this research is Amsterdam, the capital city of the Netherlands and Sommelsdijk, a small village on the Dutch island of Goeree-Overflakkee. The data presented here were collected through participant observation and in-depth interviews. I have carried out participant observation in baby playgroups, midwife practices and as a babysitter of a newborn. Furthermore I have conducted in-depth interviews with Dutch highly-educated, first-time mothers, a few significant people of their social surrounding, midwifes and kraamverzorgsters.
All interviewed new mothers reported difficulties in adapting to the new situation after the delivery of their infant. The research-objective of this study aims to show how the process of becoming a mother is intertwined with carrying out practices of doing motherhood and how these practices can establish and maintain the feeling of being related that again facilitates the transition process to motherhood. In this respect the praxeological concept of doing kinship plays a major role as a theoretical background. Three practices of doing motherhood are illustrated: breastfeeding, play time and washing of the baby. Further I give special attention to the support that is provided for new mothers in the Netherlands through grandmothers, the Dutch institutional care of kraamzorg, new parents groups and babysitters.
3
1. Introduction
“The moment a child is born, the mother is also born. She never existed before.
The woman existed, but the mother, never. A mother is something absolutely new.”
-Bhagwan Shree Rajneesh (Indian spiritual leader), 1931-1990- Lisa1 and Johannes – parents to be - shared with me the touching experience of listening to their baby’s heartbeat for the first time. While it is a dark and windy January evening outside, the excited couple, me and the midwife sat together in the tenderly furnished consultation room for the regular check-up of the pregnancy. As part of the examination the midwife held the baby heartbeat monitor right onto the 12 weeks old mother’s belly. While the bulge of the baby bump was still invisible, the baby’s heart beat loud and clear. It beat so loud and clear that there was no space for any other sound in the room and silence appeared. This silence was filled with a love and energy I hardly ever witnessed before and which grew with every further heartbeat. Not only felt I emotions coming up in myself but even more I sensed Lisa’s and Johannes’ thoughts when I looked into their eyes. Lisa’s eyes were filled with tears and from the look on her face I assumed what she was feeling: motherly love, care and affection as well as worries concerning the new demands of motherhood. From my interpretation I saw a father’s pride in Johannes’ expression. For the first time I got an idea of what it means to become a parent. That becoming a parent is for many people a magical process which is filled with myriad emotions. This little magic appeared in every conversation and interaction I had during my three months of fieldwork and never got lost. It was like a little reminder to me why I was doing this research and kept my passion alive, the passion to learn more about the little magic of becoming a parent.
4
I started the master’s program Cultural and Social Anthropology at the Universiteit
van Amsterdam having a deep interest for the anthropology of family and kinship in my mind and in my heart. Living and researching in the Dutch culture made me
curious to find out more on how pregnancy, delivery and becoming a parent is experienced in the Netherlands. Thanks to three months of fieldwork - on which outcome this thesis is built on - I discovered a whole landscape of Dutch characteristics in the postpartum period which are worth an anthropological examination. I am aware, that postpartum period is a biomedical term that is used for the first six weeks after the delivery of the infant (Hooman et al. 2014). My participants often referred to this stretch of time as “the first months” or “the time after the delivery”. However in the context of this research I will use this term to address the period of interest for this study: the first six months after the delivery of my participants’ babies.
High rates of home birth and de-medicalized deliveries in the Netherlands are frequently discussed as a ‘unique way of giving birth’ in Western societies among different disciplines. Yet postnatal experiences, perceptions and practices of Dutch new parents as well as postnatal care have mostly been neglected by anthropological researchers to date. My aim is to fill several of these gaps within this thesis.
Since the 1990s birth, reproduction and rituals linked to either have become one of the main elements of modern anthropological research on family and kinship (Levine 2008: 376)2. Interests of these studies are – amongst others - to understand
how young mothers experience pregnancy, delivery and motherhood and how their experience is influenced by the culture they are living in (Fisher et al. 2006: 68). Linked to that are the research objective and the research questions of this study which aim to understand how new, highly-educated, first-time mothers in the Netherlands experience the impact childbirth has on their life, what kind of practices are carried out in the postpartum period from mother to child, how this influences the perception of the relationship between mother and infant and by whom women are supported in their transition to motherhood.
The main theoretical concept of this study is based on the New Kinship Study’s approach of doing kinship and addresses the notion of socially constructed kinship
5
in daily interactions. I will argue that through carrying out practices of doing motherhood, a particular form of doing kinship, a feeling of relatedness is created and thus the process of becoming a mother is facilitated. I will elaborate on this further below.
Based on the insights I gained through participant observation and experiences which were shared by my informants I firstly expound how the delivery of their infant was perceived by the participants of this research and what kind of challenges and difficulties they encountered in the postpartum period. Subsequently I will give three examples of practices which were experienced by my interlocutors as contributing to the feeling of relatedness and which I therefore assume to be practices of doing motherhood. These generic practices are breastfeeding, playing with and cuddling/washing the baby. Eventually in the last ethnographic chapter I will address different supporters which provide help to new Dutch mothers in terms of dealing with their transition to motherhood and carrying out practices of doing motherhood. Grandmothers, kraamzorg, new parental groups and babysitters serve as examples to show how different kinds of support for new mothers can be carried out. In this introduction chapter I will first elaborate the context of this research, then introduce the main theoretical concept of doing kinship and afterwards go into further detail on the methods of this study.
Context of this research
Socioeconomic processes in the Netherlands – as in other Western societies - like industrialization, modernization and individualization have had a great influence on maternity and families. In this section I briefly summarize only the important developments of the last two centuries concerning the maternal role and the family in order to elaborate subsequently the current situation for mothers in the Netherlands.
Since the 1880ies there was a diminution of the family size. While around 1900 a woman had on average six children in the Netherlands, the rate of birth was 1,7 children per woman in 20133. Main reasons for this development amongst others were availability of higher education for women and them entering the labor market, a decrease in the importance of the church and its moral values and further an
6
increase in anticonception options as well as a better access to them. Furthermore a nuclearization of the family took place in the last century. Fewer and fewer extended family members or employees lived in the same household as the nuclear family and that brought a change in childrearing practices which still significantly influences the situation for contemporary Dutch parents. In smaller households the childrearing lies primarily in the responsibility of fewer people – mostly the parents - whereas the roles in bigger households may be differently distributed among several people (Brinkgreve and te Velde 2006: 98).
During the industrialization – which started in the Netherlands around 1900 - the different role allocation between women and men became more significant. Dutch women usually stayed at home to take care of household and children, while men went to work outside of the house - a development which could be observed in most European and American families (ibid: 105f.). Family and household were strongly connected with the female character, a character “knowing” how to deal with children and being caring, sensitive and emotional (ibid: 104). This still is an important notion which I came across during this research and what is also emphasized in Brinkgreves’s and te Velde’s book - women are in contemporary Dutch society still the primary care taker of the child. The current parental leave situation for new parents in the Netherlands goes back to this historical background. While a mother has in total 16 weeks of paid maternity leave before and after the delivery, only two days are due to the fathers. Beyond these 16 weeks/ 2 days of parental leave Dutch parents have the possibility to get 26 times their weekly working time free (ouderschapsverlof) to spend with their children. This ouderschapsverlof is usually not paid, depending on the employer though - as some organizations pay their employees when they are on ouderschapsverlof. In 2007 42% of the mothers and only 18% of the fathers exercised this opportunity4.
In general becoming a mother is not the only option for women in contemporary Dutch society. Rather according to Brinkgreve and te Velde women mostly have the possibility to choose for or against motherhood (ibid: 106). The informants of this research reported to have planned their motherhood consciously, at a point of time when their education – all of my participants were formal highly educated – had
4https://www.uni-muenster.de/NiederlandeNet/nl-wissen/soziales/vertiefung/erwerb/zeit.html
7
(partly) paid off and when they felt safe in their relationship and social surrounding to become a mother. This makes motherhood to a self-chosen part of life. In the course of this thesis I will go into further detail where applicable and link social and cultural circumstances with the current situation of my informants.
The role of fathers however has become increasingly important in the last decades in the Netherlands (ibid: 107). The partners of my participants were strongly involved in childrearing, supported the new mothers in various ways and wanted to play a major role in the life of their children. I focus on new mothers in this thesis but want to emphasize that also new fathers undergo a transition, experience challenges and difficulties, carry out practices of doing fatherhood and are supported by various people.
As mentioned above, the unique birth culture in the Netherlands is a frequently discussed topic in research of different disciplines on pregnancy, delivery and parenthood. As Raymond de Vries states it, there is a “small anomaly in the world of modern medicine: maternity care in the Netherlands” (2003: 43). According to him, this anomaly consists of well-educated midwifes and GPs, policlinic settings in hospitals to provide high touch birth or a system for well-child visits and of a special organization of postpartum care, the kraamzorg (ibid: 44). In fact, one of the results of this anomaly of modern medicine is that the Netherlands have the highest home birth rate and the lowest Caesarean rate among Western countries (Gooding 2004: 18). According to the latest statistics, between 2011 and 2013 18,4% of all deliveries in the Netherlands were home births and only 9% of all deliveries were Caesareans5. This can be compared to a home birth rate of 2,3 % and a Caesarean rate of 22% (both 2013) in Great Britain6. This is also related to the Dutch referral system and health insurance in the Netherlands which supports home birth: From what my participants told me, regular check-ups during pregnancy were conducted solely by midwifes and the pregnant women were only referred to a gynecologist if complications occurred.
For Gooding the Dutch birth culture is based on emphasizing the normality in childbirth and the belief, that a birth should not be unnecessary medicalized (2004:
5
http://statline.cbs.nl/StatWeb/publication/?VW=T&DM=SLNL&PA=37302&D1=0-1,45-48&D2=0,5-l&HD=110413-1418&HDR=G1&STB=T (19.06.2015 10:24)
6
8
18). Therefore the Dutch system of prenatal and perinatal care has been discussed and examined in various disciplines. From the perspective of many scholars it should serve as a model for other Western countries, whereas others criticize the Dutch system for its de-medicalization7.
As mentioned by de Vries kraamzorg is an important part of the postpartum care in the Netherlands. The first time I heard about kraamzorg was when I sat together with my new Dutch friends, whom I met right after I had moved to Amsterdam. We were talking about the professions of our parents when one of my friends said that his mother was a kraamverzorgster to which I pricked up my ears. ‘Kraamverzorgster?’ I had never heard of that. Yet as Heidema states it, the kraamverzorgster is a “uniek nederlands beroep”, a unique Dutch profession (2012: 468). Within the first eight days after the delivery - the kraamweek as it is called in Dutch - every young family receives care and support through a kraamverzorgster who spends averaging 45-49 hours in the home of the new parents. The kraamzorg, financed through health insurance, undertakes various tasks and functions. Starting with medical care, guidance on breastfeeding and scrutiny of wound healing right through to practical help such as cooking for the family, taking care of older children or cleaning the house. The kraamverzorgster is for many families the first person to ask in the unfamiliar and stirring time of the postpartum week (Croon and van der Post 2013: 233). Ideally the kraamverzorgster facilitates the development of the relationship between the new parents and the baby by showing parenting skills of all kinds (Mill et al. 2012: 664). The participants of this research all named the kraamzorg as an important and supportive help in the first week postpartum. Yet it needs to be assumed that others may experience the kraamzorg different or in less positive ways8.
7 See e.g.:
Schirm, E.; Tobi, H.; de Jong- van den Berg, L.T.W.: “Low use of medication in home deliveries in the Netherlands”. In: International Journal of Gynecology and Obstetrics, 2002, Vol. 79 (1), p.5-9.
Van der Hulst, Leonie A.M.; Van Teijlingen, Edwin R.; Bonsel, Gouke J.; Ekses, Martine; Bleker, Otto P.:” Does a pregnant woman’s intended place of birth influence her attitude toward and occurrence of obstetric interventions?” In: Birth, March 2004, Vol. 31 (1), p.28-33.
8 The amount of time a kraamverzorgster spends in a family can be adjusted to their
needs, however the kraamzorg cannot be completely rejected (Mill a.o. 2012: 666). Some parents may experience this as an unwanted intervention of the state in their private sphere.
9
1.2. Theoretical background
The notion of practices shaping our perception of family and kinship goes back to the New Kinship Studies (Carsten 2000). My aim is to show in the course of this thesis how practices of doing motherhood, a particular form of doing kinship, in relation to the child lead to the feeling of relatedness and help to overcome challenges in the process of bonding with the newborn child. The theory of doing kinship will serve as the underlying theoretical background.
New Kinship Studies
Research on kinship is one of the anthropological cornerstones and emerged in mid-18th century. For a long time in this anthropological field, notions of kinship were characterized by structural-functionalist ideas. Structural-functionalist scholars put, as the name suggests, social structure and social functions of kinship in focus. In their perspective kinship systems fulfill several functions in societies and it is (kinship) structures which shape society as a whole (Carsten 2004: 11). Thus the importance of kinship systems for people emerges from their function in a particular society. Already in the 1960s David Schneider, among others, started to reconsider the anthropological view on kinship (Peletz 1995: 344f.). The most important outcome of Schneider’s work is the new understanding of kinship as a culturally specific system (Alber et al. 2010: 9). Schneider stated that the American/ European notion of family, based on biological ties, shaped the anthropological research on kinship. Furthermore he criticized the strict distinction between biological and social kinship, made by numerous anthropologists (Schneider 1984: 189).
With this critique, Schneider “supplied a theoretical background for New Kinship Studies” (Carsten 2004: 21). The branch of the New Kinship Studies which emerged in the 1990s goes back to Schneider’s critique on anthropological kinship research (Alber et.al.2010: 10) and denies neither biological nor social relations but aims to understand the ways in which kinship relations can be constructed (Carsten 2004: 152).
David Schneider’s work and the approach of the New Kinship Studies were commented and criticized by several scholars. Schneider’s assumption that the Western idea of kinship, based on procreation and biological ties, plays a secondary role in other cultures led to a new notion of kinship within the New Kinship Studies,
10
the constructionist notion (Shapiro 2008: 137). Shapiro contests that by giving examples of numerous non-Western cultures where the perception of kinship is grounded on genealogical ties and then expanded to other areas (Shapiro 2008: 140). By doing so he tries to show that “’real’ kin are usually defined by local notions of genetic connection”, both in Western and non-Western contexts (Shapiro 2008: 145). Further he reproaches the New Kinship scholars to distance from their own ethnographic material by underplaying the role of biological relatedness in terms of
belittling the West (Shapiro 2008: 148).
Also Georg Pfeffer and Roland Hardenberg criticize the unawareness of formal kin-recognition within the New Kinship Studies (Alber et.al. 2010: 12). So the critics see a misjudgment in the failure to recognize that the idea of kinship would not exist without notions of biological relations.
As my aim within this thesis is not to contest notions of kinship but to follow the approach of the New Kinship Studies by stating that kinship is based on the performance of practices, this critique towards the notion of doing kinship plays a minor role in my research. Nevertheless I will take my participant’s notion of being biologically related with their child into consideration and argue in what ways this might influence the perception of being each other’s kin.
After Schneider’s critique to the study of kinship, anthropologists at first tended to disregard this field. The focus shifted from family systems to gender or body research. Only in the last decades, kinship studies experienced a remarkable upswing again. Topics such as homosexuality, alternative kinship and new reproductive technologies are now of high interest within New Kinship studies (Carsten 2000: 3).
Doing Kinship
The core of the New Kinship Studies lies in the theory of doing kinship and the concepts of relatedness and belonging. Besides the mentioned biological and social relations, the legal situation has a further impact on notions of kinship (Carsten 2004: 152). Nature, nurture and law are the terms used by New Kinship scholars to describe practices of doing kinship (Alber et al. 2010: 11). Nature discusses the notion of biological relations between kin which is dominant in Western societies (ibid: 11). Yet Strathern argues that since late 20th century, due to new possibilities
11
which emerge from artificial reproduction technologies, the genetic relation between people can become assisted by technology and is thus socially constructed (1992: 195). Law addresses legal defaults concerning kinship in every society, which again can be understood as socially constructed - as legal defaults are linked to cultural and social notions of kinship (Carsten 2000: 9). Being the main addressed concept in New Kinship Studies, nurture needs further explanation. The term of nurture contains predominantly the sharing of food, time and experiences, in other words the level of taking care in a kinship relation. In addition, kinship constructing rituals can also be classified as part of nurturing (Alber et al. 2010: 11). I assume the concept of nurturing to be of great importance in terms of understanding how everyday practices from parents towards their children create the feeling of being related within the postpartum period.
The main statement of the doing kinship approach is, that kinship is created, carried out and negotiated in everyday practices. Talking about practices which construct kinship, it is crucial to mention the praxeological background of the doing kinship theory. The New Kinship Studies focus on the practice of kinship and are therefore located within praxeological approaches (Alber et al. 2010:11). Following Reckwitz’s argumentation, practice theory relates back to, among others, Bourdieu’s praxeological concept (Reckwitz 2002: 243). Also Hillebrandt states that Pierre Bourdieu’s work “Esquisse d’une théorie de la pratique, précédé de trois études d’ethnologie Kabyle“ provided a foundation for following praxeological research on kinship (2009: 372). Practice theory as a cultural theory focuses on the everyday life and sees practices as the “smallest unit of society” (Reckwitz 2009: 245). A practice is a “routinized type of behavior” (Reckwitz 2009: 250), which consists of numerous levels. So are routinized behaviors “routinized bodily behaviors”, a “set of mental activities” (Reckwitz 2009: 251) and “ways of understanding, knowing how, ways of wanting and feeling” (Reckwitz 2009: 253) to name but a few.
Taking a closer look at the practices highly-educated, first-time Dutch mothers perform in the postpartum period, helps to understand how kinship is created and carried out in this particular society. In my perspective these practices initiate the feeling of being related and point to my participants’ understanding of kinship. In respect to adapting this theoretical concept to the aim of this research, I will refer to the practices carried out by the new mothers as practices of doing motherhood, as
12
these practices initiate, establish and maintain a particular form of kinship – motherhood.
Feeling of Relatedness
As a consequence of the shift in anthropological kinship research, scholars of the New Kinship Studies rejected the term of genealogical grounded kinship and replaced it with the concepts of relatedness and belonging (Alber et al. 2010: 10). These terms make it obvious that kinship is always under construction. Feeling related is being related and therefore moves away from the notion that kinship is given (Carsten 2000: 4). Again practices of nature, nurture and law lead to the feeling of being related (ibid: 18).
In my research, all participants referred to themselves as being biologically and legally related with their child. Yet it will be shown how nurturing practices such as nourishing the baby or spending time together, were experienced as the most important doing kinship factors. The notion of taking care of a newborn led in different ways to a feeling of being related for the participants of this research. 1.3. Methodology
Many coincidences, obstacles, chances and pieces of luck shaped this thesis and so it is that this research is far more a result of serendipity, helping hands and co-thinkers than of my actual planning. This thesis is the result of all the small and big turns, setbacks and new ideas I encountered during planning and being in the field. When I started the Cultural and Social Anthropology master’s program at the Universiteit van Amsterdam, my aim was to study surrogacy in the Netherlands. Fascinated by the theory that kinship is constructed, I wanted to study how surrogacy is perceived in the Netherlands. Due to the fact that surrogacy is not very prevalent in the Netherlands and that I was told that Dutch parents of a surrogate-child mostly feel over-researched as there are only a few, I decided to change my research focus. I started my fieldwork with the idea to study how postpartum depression influences practices of doing kinship. Initially I intended to – besides conducting interviews with postpartum depressed mothers - talk to some non-affected mothers to be able to compare their behavior of doing kinship with the practices postpartum depressed mothers carry out. At the end of my fieldwork
13
period I had spoken to a few postpartum depressed mothers, but I gained even more insights on how healthy new Dutch mothers experience the first six months postpartum. I was already considering, but needed a little hint and help from my supervisor to decide and write my thesis on practices of doing motherhood in the Netherlands. So this thesis focuses not on exceptions as surrogacy or postpartum depression but instead on what sounds to be so “normal” which is becoming a mother in the Netherlands.
Study design
The data I present in this thesis are based on qualitative research over a period of twelve weeks (January till March 2015) in Amsterdam, the capital city of the Netherlands, and Sommelsdijk, a small village on the island of Goeree-Overflakkee in Zuid-Holland. Data firstly was collected with the help of participant observation. During the twelve weeks of fieldwork I attended two baby playgroups in Amsterdam on a regular basis once a week. Further I was present at another baby playgroup four times during the fieldwork period. These playgroups were conceptualized for young parents - yet only mothers participated - with babies between 1-12 months age. The attendance varied from week to week but with an average of ten to sixteen young mothers per group meeting. My participant observation was shaped by participating in singing songs and playing baby games, taking part in conversations between the new mothers and observing practices between mothers and their infants.
Moreover I observed practices of the time before and after the delivery while I accompanied a midwife for three days in Sommelsdijk and with another midwife for four days in Amsterdam. During this period I followed the midwifes in their daily work, to their home check-ups and consultation hours. During three out of nine home visits which I have attended, I was also able to observe parts of the work a kraamverzorgster does in a family in the first week postpartum. A further fruitful participant observation I experienced in the process of the research was my work as a babysitter in a young family with a four month old baby. I went there two to three times a week and babysat always for three hours. This gave me the possibility to experience firsthand insights of a new mother as Liv, the mother of the baby I looked after, often stayed at home while I was there. I learned a lot not only about
14
taking care of a baby, but even more about what being responsible for a newborn feels like and where challenges and difficulties lurk.
Beyond participant observation I conducted in-depth interviews in the form of semi-structured interviews with eleven young mothers whose babies were between six weeks and six months old. Further I interviewed three partners of my participants, the fathers of their newborns, and one grandmother, the mother of one of my participants. All but one of these interviews were conducted in the homes of my informants, which gave me further insights on their family life at home. In addition five midwifes and six kraamverzorgsters were interviewed. All of my informants but two kraamverzorgsters and two midwifes who came from the island of Goeree-Overflakkee, lived in Amsterdam. In this thesis, the data I gained through interviews with postpartum depressed mothers is excluded and I am using only the material I received through the healthy new mothers I have talked to.
Selection of interlocutors
The playgroups and my main gate keeper, a midwife and former student of medical anthropology and social media were the starting points for the selection of my participants. From there on I used the snowball method to get in contact with young mothers, midwifes and kraamverzorgsters.
All new mothers I have interviewed were between 30 and 38 years old. They and their partners, as well as the grandmother I had spoken to had a high-education degree and still worked or had worked until their advanced pregnancy in an academic career. Further similarities between my informants are that they all lived in a heterosexual relationship and in one household with the father of their newborn. Putting a focus on high-educated mothers in this study was initially not intended. Yet in the course of the fieldwork only high-educated mothers replied to my research request. One explanation might be my own academic background and therefore the social surrounding I am in. Further I assume that highly educated mothers are more likely to attend baby playgroups that are held in another language than their mother tongue. The people of their social surrounding, which I reached through snowball method, consisted also mainly of high-educated people. In addition I experienced in the process of my fieldwork that people with high-formal education had a better understanding of anthropological research and therefore were
15
more willing to participate. Midwifes in the Netherlands also undergo a higher professional education whereas kraamzorg in the Netherlands is an apprenticeship education.
Reflection on my role as a researcher
In the Netherlands traditional notions of the woman being responsible for childrearing, household and family are still of high importance – in particular giving birth, the postpartum period and baby care is strongly connected with the female. I almost only spoke with female interlocutors. In this respect I experienced it as helpful to be a woman myself. I felt that the women I interviewed allowed me to be a part of their circle in a way they might not have allowed a man to take part.
Many times I was under the impression that my interlocutors viewed me not so much as a researcher but as a potential mother-to-be with whom they liked to share their experiences. In addition I assume that also my age had a big influence on the perception of me as a researcher. Although I am a couple of years younger than many of my interlocutors I experienced that they could identify with my life situation and me. Their own university degree was not too long ago and being 26 years old, I belong to the potential mother-to-be circle my interlocutors have also been part of before they became parents.
Being a woman I was able to observe breastfeeding practices, I was told about physical pain concerning the uterus or the vagina. My informants spoke with me about the way their body has changed, the losing or gaining of weight, stretch marks and how this changed their awareness of the self – all very sensitive topics - in a way they might have not done with a male researcher.
Nevertheless I am not a mother yet. I cannot comprehend all my participant’s experiences in a genuine way. On the one hand I experienced this as an advantage as the participants did not posit any knowledge on my side and thus gave me more detailed accounts. On the other hand though I also heard answers such as ‘It is indescribable, you have to experience it, only then you can know’. This hinted at the ineffability and the complexity of the experience of the transition to motherhood. Another issue which influenced the insights that I gained from my research was the language in which I conducted my interviews in. As Amsterdam is an international
16
and cosmopolitan city it was easy to get along without speaking Dutch and the interviews I conducted in Amsterdam were mostly in English. Nevertheless I wanted and needed to learn Dutch as my participants on the island Goeree-Overflakkee were mostly not very familiar with English. I started learning Dutch two months before I went to Goeree-Overflakkee and by that time I was able to understand most of the conversations, but it was still difficult for me to create follow-up questions in interviews. While I transcribed the interviews I have accomplished in Dutch, I recognized that some information got lost because I either did not understand everything my informants were saying or I was not able to pick up the information and transfer it into further follow-up questions. Nonetheless I experienced the diversity of languages - I also conducted two interviews in my native language German with two mothers who have been raised bilingual in German and Dutch - as fruitful for my research. Using more than one language forced me to constantly find new words to explain my research interest and thereby helped me constantly to reflect on my study and the data.
As mentioned, I am from Germany and only moved to Amsterdam six months before I started the fieldwork. I experienced my German perspective as being helpful for this research. The German culture might be seen as being similar to the Dutch culture, yet especially birth and postpartum care is organized in very different ways. From my point of view the German culture in which I have been socialized in was on one hand distant enough to the Dutch culture I have researched to see practices which might be self-evident for someone being raised in the Netherlands. On the other hand the similarity between German and Dutch culture helped me to understand the language and behavior of my participants better. For me the distance between the culture I come from and the one I have researched was ideal, although I think that a longer period of living in the Netherlands would have been better to get a deeper understanding of the Dutch culture. My supervisor – coming from the Netherlands – often hinted to issues that I as an “outsider” had experienced different to her own insights of the Dutch culture.
What has been a limitation in terms of research on postpartum depression – the difficulty to find interlocutors with postpartum depression who wanted to share their experience – turned out to be an advantage for this research as I was able to gain insights on how new Dutch mothers experience their transition to motherhood and
17
what kind of practices of doing motherhood are carried out. Yet I encounter the change of my research-objective also as partly negative for the outcome as I could have gained more data on the topics I am discussing now if I had had this focus from the beginning of my fieldwork.
Outline of the thesis
In three ethnographic chapters I will elaborate in this thesis how Dutch new mothers experience and carry out their transition to motherhood. In the first ethnographic chapter “Becoming a mother: a rite de passage” I will show that childbirth is experienced as a major life event. According to van Gennep’s concept rite de passage this major life event is ritually marked to facilitate the transition process. Challenges and difficulties of the postpartum period can be seen as markers of this transition to motherhood and I will show in what ways different life spheres of my participants were affected by their new maternal role. Subsequently in the second ethnographic chapter “ Practices of doing motherhood” I focus on three practices – breastfeeding, playing with the baby and cuddling/ washing the baby - which are carried out by the new mothers towards their infant. These practices were named as contributing to the feeling of relatedness and I argue that this feeling of relatedness facilitates the transition to motherhood and the carrying out of the maternal role. In the last ethnographic chapter “Practices of doing motherhood: support” I will show how different people and networks provide support for new mothers in the Netherlands. I have chosen four different supporters – grandmothers, kraamzorg, new mothers groups and babysitter – to illustrate that different people and networks provide various kinds of supports for new mothers in the Netherlands.
18
2. Becoming a mother: a rite de passage
In the late morning, Stefanie, the midwife, and I were driving for a regular check-up visit to Martha, a 30 year old woman who delivered her son Levi two days ago in a birth center. Where the young family lived could be seen from far and wide. Their home in the new housing estate was decorated throughout with little blue flags and next to the front door stood a huge ‘muisjes verpakking’9 with Levi’s name on it.
The decoration indicated what waited inside, the turbulent home of a very young family. We rang the bell and waited a while until someone opened the door by pressing the electric door opener. No one welcomed us as we entered so we took off our shoes and walked inside. From the living room I heard the TV sound and from the kitchen I could smell the scent of eggs and burnt toast. We heard a voice from upstairs calling us up to the parent’s bedroom. As we climbed the stairs the baby began to cry and the father of the infant, Dirk, greeted us at the top of the stairs. He wore his pyjamas and seemed somewhat dazed but also happy. With his mobile phone in his one hand and an agenda in his other hand, he then brought us to the bedroom where Marta awaited. As we entered the room, she started to cry and Stefanie mumbled ‘Ah the baby blues’. Marta tried to get up but then cradled her belly and her back in pain, it seemed that they did hurt too much and so she remained in her bed. Her breasts were packed in cold cataplasms which - as I know now- were to ease the pain she had from breastfeeding. Things for the baby were everywhere in the room and Stefanie and I did not know where to sit. While we waited for Dirk to bring two chairs, Marta began apologizing for the mess and that she had not prepared anything for our visit. Although I was very happy and excited to be around the house and these unfamiliar settings, I also felt like an uninvited guest intruding ones a young family’s privacy. Then the kraamverzorgster Ingrid came into the bedroom. Without hesitation she cleared up the windowsill and asked Stefanie and I to sit there. She explained that Marta had been a bit weepy since that morning, ‘de kraamtranen’ (Dutch for baby blues), she summarized the situation with one word. I felt how her expert knowledge and her humor filled the room. She reminded me of a grandmother with a nurse smock and spread the feeling that everything was easy and good. After she had caressed Marta’s cheek, calmed Levi
9 See page 4. The company who produces the muisjes offers to print the name of the baby on the
19
and discussed the current weight and iron level of the baby with Stefanie, she left us alone with Marta to get everyone a piece of cake she had baked that morning.
Beschuit met muisjes („rusk with little mice“): a special treat in the Netherlands to celebrate the birth
of a newborn. Beschuit met muisjes are served to visitors within the kraamweek (the week after the delivery of the baby). The round rusk is buttered and then topped with sugar-covered aniseed in different colors: pink-white for a girl and blue-white for a boy.10
Giving birth to a baby has far-reaching influences on almost every area of life for young mothers and the delivery of a newborn is in nearly all cultures perceived as one of the most important happenings within the life course (Kumar 1994: 250). Within this chapter I will explain how first-time, highly-educated Dutch mothers experience the first months after the delivery of their infant. Based on van Gennep’s concept of rite de passage I will demonstrate how the new Dutch mothers of this research perform their transition to motherhood. Further I will elaborate how challenges and difficulties in the first months after childbirth can be seen as markers of this transition phase to motherhood. These challenges and difficulties contained
20
for the participants of this study changes in the body of the new mothers, difficulties in adapting to the rhythm of the baby, the work life of the women and changes in the relationship with significant people.
Clara, a 31 year old primary school teacher and mother of 5 month old son Christiaan, illustrates this phenomenon in our interview over a cup of coffee in her living room:
No matter how many prenatal courses you go to, how many books on delivery and motherhood you read, no one can prepare you for what is coming. Becoming a mother is new and exciting and frightening.
Clara had wanted to become a mother since her teenage days and when she discovered she was pregnant pure happiness and joy overcame her. Being very excited about the pregnancy she attended two prenatal courses, talked a lot to friends who were already mothers and read up much information in books. Despite all this preparation, she described a feeling of being lost after the delivery:
I thought the delivery would be the problem. If only! I only prepared and worried for the pain and everything but it is the time after the delivery for which you actually should prepare […] My head was empty, I had no thoughts or feelings anymore and I felt like I am in a vacuum without time and space.
Tilda, a 32 year old occupational therapist from Amsterdam, also made similar remarks about her experiences with the delivery of her own 4 month old baby Nienke. About the delivery inherently she told me:
You cannot imagine how it is. It is incredibly painful and it is incredibly heavy. It is a world change; yeah it is like you are going to die.
She described her feelings in the weeks after giving birth as being:
Like a jetlag. That is a good metaphor. I felt like I landed in a totally new world. I didn’t know my direction and where to go. And I also didn’t know the words to ask for something because they spoke another language. Yeah that is how I felt, like a big jetlag.
21
Nena, who has worked as a midwife for ten years by the time of our interview, confirmed what I was told in interviews and observed during the consultation- hour in the midwife practices. Pregnant women tend to focus on questions concerning the delivery itself, whereas they assumed the time after the childbirth to be ‘natural and easy going’. Questions which were asked by the future mothers in the consultation hour of the midwifes were mostly about medical advice concerning the pre- and perinatal period. Apparently the delivery seems to be more frightening than the postpartum time and many mothers-to-be underestimate the impact a delivery has on their whole life. Also Delmore-Ko et al. found similar results in their study on prenatal expectations and postnatal experiences. Although their research among new American parents revealed that a high extent of preparation for parenthood helps in adjusting to the new situation, the well-prepared participants of their examination also perceived the postpartum period as a crisis in their life given the new demands they were facing (2000: 626 f.).
Hofecker Fallahour et al. advance that from a psychologist point of view, the postpartum period is shaped by radical changes and profound adjustments (2005: 51). In order to deal with these developments, people tend to establish patterns and practices (Stern and Kruckman 1983: 1031). The “ritual marking” (ibid: 1033) used to mark major life events, of which giving birth is one example, is established in van Gennep’s anthropological concept of rite de passage.
Gennep’s approach categorizes different transitions in life (e.g. from childhood to adolescence) and linked behavioral patterns as rites de passage. These rites are supposed to help people cope with the transition and the new demands placed on the individual (van Gennep 2005[1909]: 115). Also during pregnancy and the birth of a child, there is a transitional period for both mothers and fathers (ibid: 43). The process of becoming a mother affects a woman’s body, her status in society, emotions and the way she identifies herself. In nearly all cultures the mother is seen as “the primary care giver” for a child (Cox 1996: 9).
Culture specific rites help to cope with changes which come along with the transition to motherhood (Raphael 1975: 65). According to Raphael the matrescent rite de passage consists of a set of practices (ibid: 67) and three phases of this matrescent rite de passage are identified: first the woman withdraws from her current status and prepares to move to the next status, second the woman has left her
22
old status but not entered her new one and third the re-integration phase in which the mother re-enters society in her new status (Neiterman 2012).
Withdrawal and preparation for motherhood
For all of my interviewees the preparation for motherhood started immediately after they found out that they were pregnant. Many reported the fear of losing their baby as being dominant in the first 12 to 16 weeks of pregnancy and therefore they did not want to tell too many people or start buying baby clothes. Indeed is the risk of a miscarriage the highest within the first three months after fertilization (Quenby 2002: 170). My informants reported that they knew about the risk of losing the fetus either through their midwifes or because they had friends who experienced a miscarriage in the first three months of the pregnancy. Despite the fact that the women I spoke to were all very careful about creating too much pleasant anticipation, all reported that they started dreaming about the baby and imagining how motherhood might be. And many reported that they increasingly started to notice other mothers and babies on the street and looked up information in online forums and books. After the first three critical months, the withdrawal from the current status was initiated by informing the social environment about the pregnancy. My interviewees reported this as being a very important step in the process of becoming a mother. As Alexandra, a 34 year old project manager in marketing told me:
As soon as I told everyone, I felt that this is really going to happen. Before that the pregnancy was more like a dream, a secret only I and my husband knew but then I shared my happiness with everyone. I loved telling people that I am pregnant and I was always curious how they will react.
The more advanced the pregnancy was, the more my interlocutors prepared for the birth. As a culturally specific phenomenon it can be stated that all the women who participated in this research also took part in prenatal courses to prepare for the delivery. In a culture in which deliveries and childrearing are not necessarily part of the daily life for women, prenatal preparation courses provide information and knowledge for pregnant women. Prenatal preparation courses started for them between the sixth and seventh month of pregnancy. Although there were a substantial number of these prenatal courses on offer in Amsterdam, my participants
23
reported that they needed to apply very early in their pregnancy to be given a place. This shows that the prenatal courses are a frequently used preparation option for Dutch pregnant women. I have made similar observations in Germany, where many of my friends who are already parents participated in prenatal courses to prepare for parenthood. These courses were usually designed for the pregnant women and to one to two meetings the partners were asked to accompany them.
Other steps like the furnishing of the baby room and buying of baby products can also be seen as a preparation for the new life stage. The young mothers I talked to found the selection and purchasing of baby accessories as a very important time during their pregnancy. My interviewees and their partners reported that spending time carefully choosing which products were the best for their helped them in having the feeling that they were already doing the best for their child. Jeska (31 years old and web designer) remembered:
On the one hand I enjoyed the pregnancy and was happy that I had time to prepare. On the other hand I couldn’t wait for the baby to come. So for me checking all the products we needed as a pastime. I was imagining how the baby will look like, what clothes will be cute for it and so. And then I got a little obsessed about the baby mattress. I just wanted to buy the right stuff, no bad additives and so. And I was really afraid of the sudden infant death. I thought if I choose the perfect mattress I am doing everything right.
Transition Phase
The transition phase into motherhood starts with the delivery (Neiterman 2012). As mentioned in the introduction, a lot of research has been conducted on the way of giving birth in the Netherlands. My aim now is to focus on the transition phase into motherhood which takes place after the delivery. In the Netherlands, the kraamweek, the first eight days after childbirth, can be understood as part of the rite de passage to cope with the new circumstances. The kraamweek contains rituals and practices to deal with the impact the arrival of a newborn has on the young family. Within the transition period of the kraamweek practices are established to relieve the new mother, assure her in her new maternal role and support her in carrying out practices of doing motherhood. This includes for instance the tradition of serving
24
beschuit met muisjes (see page 4) to all visitors in the kraamweek. Beschuit met muisjes were something that all of the participants of my research took for granted. I wanted to know why beschuit met muisjes were served in the kraamweek and some told me to have never thought about it and said “it is simply the case”. Others named two reasons: Firstly, beschuit met muisjes are very easy and quick to prepare so the new mother does not have to worry about what she serves her family members and friends who are visiting during the kraamweek. Secondly, the ‘muisjes’ are made of aniseed and they are traditionally believed to be beneficial in getting rid of evil spirits and also in stimulating lactation.
Of major importance is the support kraamverzorgsters provide for the young family. During the whole kraamweek kraamverzorgsters spend an average of 8 hours per day in the family and take special care of the new mother and the newborn. I have observed how a kraamverzorgster provides knowledge and support for new mothers during a postpartum check-up with the midwife:
… then Ingrid came back with the cake and the plates in her hand. I got the impression of a caring grandmother who stays on the sideline but organizes the whole family from there. Her constant smile and sanguine entity filled the room and Marta appreciated her help by saying ‘she is our good soul of the house now’. As I have never seen a newborn’s first bath before, Ingrid asked me if I want to be there and see how Levi gets his first bath today. This pleased me so greatly and filled me with warmth and confidence. I was asked to get a bucket from the kitchen and fill it with water which is between 37 and 38 degree Celsius warm. When I came back to the bedroom, Ingrid had already prepared the double bed by lining it up with many towels. Marta was too weak and in pain to get up and Ingrid decided to bath Levi right next to his mother so that she could see everything. First Ingrid asked Marta to squeeze a bit of her breastmilk into the bathing water, as she explained this is the best soap for newborn and also helps to reduce sore points on the baby’s skin. Then she asked me to put Levi into the water and hold him under his arms. He immediately started to cry. While Marta and I were listening, Ingrid told us that it is important that the baby’s feet touch the edge of the bucket. As she said, in this way the newborns do not feel lost in the water and do remember the feeling of being in the uterus and as I held Levi’s feet against the edge of the bucket he stopped crying…
25
The experience of working with young mothers and newborn babies as well as the practical knowledge and skills are major benefits of the kraamverzorgster from the perspective of my informants. They appreciated that the kraamverzorgsters conveyed comfort and encouraged them in dealing with the baby as well as in gaining more self-confidence in their own abilities as a mother. After the delivery my participants found themselves in a completely new situation and many experienced a feeling of being lost. As mentioned above, giving birth to a baby changes many spheres of life. Yet first and foremost practical things concerning the baby need to be learned. All my interlocutors felt that shortly after the delivery questions arose on how to dress their newborn, how to carry a baby or how to give them a bath. In all these matters the kraamverzorgster turned out to be a very useful helping hand as they combined the practical knowledge with a caring, understanding nature. Another advantage which was named in the interviews is the amount of time the kraamverzorgster spends in each family. Knowing that the kraamverzorgster stays for eight days and that they have quite a bit time to learn how to deal with the basic demands, gave the new mothers assurance and confidence that they needed to be able to adapt to the needs of their baby.
Further support is provided through the kraamverzorgsters by integrating the new father as well as the siblings of the newborn into the routines of the baby. This can help to provide relief for the young mothers who often believe that they are the only ones who are responsible for the nursling. Malika (34; translator) told me:
It was good that she also showed Isaac [her husband] how to do stuff. In the first days I thought ‘I am the mother, I have to do everything’. But the fathers can also do a lot and I was happy she showed us how.
Not only are the fathers and siblings of the newborn integrated into dealing with the baby but the kraamverzorgsters also take care of them – for example by bringing older children to school or preparing packed lunch for the fathers - so that the new mothers can concentrate on themselves and her newborn. Further help provided by the
kraamverzorgsters in bigger and smaller domestic tasks allows the mothers to get rest in the kraamweek. The new mothers I have talked to, appreciated the help which was provided through the kraamzorg. As mentioned in the introduction, this Tilda shared with me her feelings from the first hours after she has returned home from the hospital with her newborn daughter Nienke:
26
And then in the morning she came. She knocked on our door and when I opened she asked us, if we had breakfast. ‘Breakfast?’ I said. I did not even know what time it was or how to cut bread. I did not even know if I should be hungry or anything so I was very thankful someone came to take care of us.
Susanne, 38, another interlocutor of mine who I met with her six month old son Daan in one of the playgroups emphasized the role her kraamverzorgster played in the first week postpartum and how she took care of Susanne:
Pina, my kraamverzorgster, she is a schatje (Dutch for “treasure”). She told our visitors to leave when I was too exhausted. And she would always pick up the phone so that I could stay in bed. Even more she not even allowed me to get up at all. She did everything for me.
Every new mother I have talked to felt well supported by the kraamverzorgster, and that all the basic needs that they had were being met. The interviews also revealed how the kraamzorg can be aligned to each family’s needs and is therefore very individual. My 33 year old interlocutor Nanda, who formerly worked as a surgeon and is now on paid maternal leave, is mother of her son Samuel who was born 3 months before our interview. She liked to think back to her kraamverzorgster and told me:
First of all she showed me how to put a diaper on. Believe me or not but I have never done this before. And then we did all these little daily things. Cutting Samuel’s nails for the first time and she said that I have to check his temperature every day in the first week. Also she taught me all the good night songs I still sing to him […]. What was also important, she showed me how to handle the baby sling. First that was a disaster but after we have done it a couple of times together it worked out well.
In contrast to this, Linda (31) who is mother of a 3 month old girl called Mia, had already had experiences in dealing with newborns as she is a children’s nurse. She was more thankful how her kraamverzorgster Pauline dealt with visitors and the household: So she told me there is this rule that no visitor is allowed to stay longer than 45 minutes. At the beginning I thought ‘Oh my god, this is so short’. What did I know! I loved that people came over to see us but after 30 minutes my body and mind felt tired. So I was very thankful that she already told everyone beforehand that they should
27
leave after 45 minutes.[…]. And when I slept for a while and came back to the kitchen or living room everything was nice and clean and comfy.
What can be seen here is that the very practical help which is provided by the kraamverzorgster serves the purpose of giving the new mother time and space to find her own way of mothering in the first week postpartum. The fact that the kraamverzorgsters overtake numerous tasks in the kraamweek, depending on what the young mothers need the most, assures that there is less pressure on the new mothers to take care of everything. The kraamweek constitutes a short transition phase for young mothers in which they can learn, practice and prepare with the help of the kraamverzorgster for the upcoming time with the newborn. I will come back to the support kraamverzorgsters provide in chapter 4.
Re-integration into society
The third stage of the maternal rite de passage is the re-integration of the new mother into the society. In Western cultures this incorporation is usually carried out individually and gradually (Davis-Floyd 2003: 42). The participants of this research named different steps as important in the process of their reintegration into society as the transferred self as a mother. Firstly, leaving the house for the first time after the delivery was a decisive experience for my participants. Malika told me in this regard: It took me two or three weeks until I left the house with Manuel. Before that I was too afraid, I didn’t know if I was ready to go outside. At home I felt safe at home but not outside. Slowly I started to do the groceries again or just went for a walk.
Similar experiences were shared by many of the new mothers I have talked to. Nanda, whose son Samuel was 5 month old by the time of our interview, reported:
Before the delivery I thought I could do everything with my baby right after the delivery. But know when I see mothers who are in the supermarket with a newborn who is only a couple of days old I wonder how they manage this. I think I started doing the stuff I used to do only after three weeks after the delivery or. And then only the basic things like shopping or so. Before that even going to the doctor was sometimes too much for me. I wanted to stay at home and take my time to get used to being a mother. But it did good to me when I went back to normal. I felt that I had everything under control again and I had also missed to do all that normal stuff. You know people say
28
‘You are not ill you are only pregnant’ but after the delivery it took me a while to go back to normal.
As these quotes show is the re-integration into society often linked to going back to what the new mothers experienced as being normal. In the first weeks after the delivery the new mothers are in an exceptional state, they stayed most of the time at home, many people came to visit the newborn and its mother – thus the daily cycle of the women who just had delivered is likely to be confound.
This exceptional state ended for the mothers who went back to work after the paid maternal leave with their re-entering of the work life. Joanna, who started working again as a psychologist six weeks after the delivery of her daughter Yule, told me: On my first day back at work I had mixed feelings. I missed my daughter. In the morning, I didn’t want to leave the house. But back in the practice I felt like my old self again. Of course I was a mother now but being at work reminded me that I am more than that. Now I enjoy going to work a lot. Yule is in good hands with the babysitter and I enjoy the time I have with her in the evening and on my day offs a lot.
From my perspective the re-integration into society for the new mothers of this research was strongly connected to carrying out practices they used to do before the delivery. Doing groceries, going for a walk with the baby, going on holiday for the first time with the baby and often most important, going back to work was named as steps of the re-integration into society. This shows that this was not a linear process but happened partly parallel to the transition process after the delivery.
