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Silence, Stigma, and Shame: Distress During the Menopause Transition
PROMOTORAS DE SALUD AND PORTION CONTROL: A COMMUNITY INTERVENTION AIMED AT WEIGHT LOSS IN LOWINCOME MEXICAN-AMERICAN WOMEN Mary Ann Faucher, CNM, PhD (Baylor University) Purpose: To pilot test a brief intervention in portion control. Research Question: Does portion control intervention, in a community of low-income Mexican-American women, lead to significant weight loss? Hypothesis: Low-income Mexican-American women will have significant weight loss after an intervention in portion control. Significance/Background: Traditional approaches to care have done little to narrow the gap of health disparities. A significant health disparity is the rising rates of overweight and obesity in MexicanAmerican women. Methods: A 20-week randomized control trial in 19 low-income Mexican-American women. The intervention consisted of four 2-hour classes. The control group received routine care. Both groups were led by a certified nurse-midwife (CNM) and a promotora de salud (lay health advisor) team. Findings: Women in the intervention group lost more weight than women in the standard care group. The mean weight loss in the intervention group was 6.57 pounds (2.9 kg) compared to a mean weight loss of 2.8 pounds (1.3 kg) in the standard care group (P ⫽ .47). Mean weight loss, regardless of group, was greater when participants stated that they exercised 2 or more days a week (P ⫽ .35) and when participants reported self-weighing (P ⫽ .02). Discussion: A community-based partnership in portion control led by promotoras de salud in partnership with CNMs is an effective intervention for weight loss in low-income Mexican-American women that merits further study. REALITY TELEVISION AS A SOURCE OF INFORMATION ABOUT BIRTH: THE MESSAGES AND THEIR IMPLICATIONS Alicia VandeVusse, MA (University of Chicago) Leona VandeVusse, CNM, PhD, and (Marquette University) Purpose: Childbirth information in reality television programs needs critical examination. Messages regarding interventions and options were examined in the most popular show, A Baby Story. Research Question: How prevalent are medical interventions and potential alternatives on A Baby Story and how are these discussed by program participants? Significance/Background: Two-thirds of expectant mothers watch childbirth reality television programs, while maternal–infant outcomes worsen, medical intervention rates increase persistently, and midwifery remains underused. Methods: Forty episodes of A Baby Story were randomly sampled, recorded, transcribed, and analyzed for content, including frequencies of depicted birth options and interventions as well as comparisons by provider type and birth method. Conversations about childbirth
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and birth sequences were coded to evaluate discussions. Findings: Physician-attended births predominated (74%) and depicted routine interventions as necessary to facilitate labor progression and minimize pain, allowing medicalized births to appear normative. Alternative birth options were unclear and infrequent, occurring most often when midwives attended or when birthing women were identified as particularly well informed or motivated to avoid intervention. Discussion: Episodes of A Baby Story were not neutral arbiters of information. The majority mirrored the medical model, reinforcing women’s fears about pain while inconsistently mentioning alternatives. As impersonal sources of birth information become more common, media messages that normalize medical intervention in childbirth need to be countered. Offering accessible, interesting, widely available information supporting midwifery and childbirth options seems a valuable national strategy. SILENCE, STIGMA, AND SHAME: DISTRESS DURING THE MENOPAUSE TRANSITION Marcianna Nosek, CNM, MPH, PhD, Holly Powell Kennedy, CNM, PhD, and Maria Gudmundsdottir, RN, PhD, CT (University of California–San Francisco) Purpose: Some women experience symptoms during the menopause transition that lead to consequent distress. This study explored the experience of distress for women during the menopausal transition. Research Questions: From the perspective of the woman during the menopause transition, what is the essential experience of distress? How do women describe the relationship between aging and menopause? Significance/Background: A decreased quality of life is a consequence of distressful menopausal symptoms. Many risk factors for distress during menopause have been explored with some reinforcing negative stereotyping. Methods: Postmodern feminist theory and narrative analysis methodology were used to facilitate the understanding of how each woman defined distress and how this reflected the shared meanings imbedded in American society. Interviews of 17 women were digitally recorded and transcribed verbatim. Data were re-transcribed into narratives and poetic structures. Findings: The women experienced a range of distressing symptoms. Themes of silence, shame, and stigma related to aging and menopause were identified. Contradicting social discourses and the specific context of each individual’s life were found to greatly impact experiences of distress. Conclusion: Some women may be experiencing symptoms with a potential for distress and decreased quality of life. It is imperative that we understand the meaning and context imbedded in the women’s experiences. Efforts need to be made to decrease the isolation and stigma associated with menopause and aging women.
Volume 53, No. 5, September/October 2008
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and birth sequences were coded to evaluate discussions. Findings: Physician-attended births predominated (74%) and depicted routine interventions as necessary to facilitate labor progression and minimize pain, allowing medicalized births to appear normative. Alternative birth options were unclear and infrequent, occurring most often when midwives attended or when birthing women were identified as particularly well informed or motivated to avoid intervention. Discussion: Episodes of A Baby Story were not neutral arbiters of information. The majority mirrored the medical model, reinforcing women’s fears about pain while inconsistently mentioning alternatives. As impersonal sources of birth information become more common, media messages that normalize medical intervention in childbirth need to be countered. Offering accessible, interesting, widely available information supporting midwifery and childbirth options seems a valuable national strategy. SILENCE, STIGMA, AND SHAME: DISTRESS DURING THE MENOPAUSE TRANSITION Marcianna Nosek, CNM, MPH, PhD, Holly Powell Kennedy, CNM, PhD, and Maria Gudmundsdottir, RN, PhD, CT (University of California–San Francisco) Purpose: Some women experience symptoms during the menopause transition that lead to consequent distress. This study explored the experience of distress for women during the menopausal transition. Research Questions: From the perspective of the woman during the menopause transition, what is the essential experience of distress? How do women describe the relationship between aging and menopause? Significance/Background: A decreased quality of life is a consequence of distressful menopausal symptoms. Many risk factors for distress during menopause have been explored with some reinforcing negative stereotyping. Methods: Postmodern feminist theory and narrative analysis methodology were used to facilitate the understanding of how each woman defined distress and how this reflected the shared meanings imbedded in American society. Interviews of 17 women were digitally recorded and transcribed verbatim. Data were re-transcribed into narratives and poetic structures. Findings: The women experienced a range of distressing symptoms. Themes of silence, shame, and stigma related to aging and menopause were identified. Contradicting social discourses and the specific context of each individual’s life were found to greatly impact experiences of distress. Conclusion: Some women may be experiencing symptoms with a potential for distress and decreased quality of life. It is imperative that we understand the meaning and context imbedded in the women’s experiences. Efforts need to be made to decrease the isolation and stigma associated with menopause and aging women.
Volume 53, No. 5, September/October 2008