“Listen to your body”: A qualitative text analysis of internet discussions related to pregnancy health and pelvic girdle pain in pregnancy

https://doi.org/10.1016/j.pec.2008.02.002Get rights and content

Abstract

Objective

To explore popular perspectives on pelvic girdle pain (PGP) in pregnancy through an analysis of women's discussions on the internet, and to investigate how these discussions compare with the prevailing official discourses on PGP and pregnancy health.

Methods

A qualitative text analysis of women's contributions to a commercial online web-based discussion forum related to PGP in Norway.

Results

The website works as a meeting point between pregnant women seeking advice on how to interpret and handle pregnancy-related pain, and women with experience of PGP. The worries expressed are met with strong messages of precautions and self-care, and in general PGP is perceived as an unpredictable and potentially disabling condition.

Conclusion

A popular discourse on PGP as an “unpredictable condition” emerges in the discussions, and challenges the official discourse on PGP as a “common complaint”. The “unpredictable condition” discourse may work to justify pregnant women's perceived need for rest and care, and may be interpreted as an expression of a lack of acknowledgement of pregnancy as a state of being that requires special care in contemporary Norwegian society.

Practice implications

This popular discourse reflects a gap between the policy of pregnancy as a normal condition, and women's experiences that should be taken seriously in policy-making and medical practice.

Introduction

The tension between the discourse on pregnancy as a normal condition for women and the high frequency of medically certified sick leave for the same population is a paradox in maternity care in Norway today. While as many as approximately 60% of Norwegian women experience a period of sick leave during pregnancy [1], [2], [3], pregnancy in itself is defined as a normal physiological process for the majority of pregnant women [3]. During the last decades increasing attention has been paid to pelvic girdle pain (PGP) in pregnancy [4], which is an ill-defined and poorly understood condition. PGP is classified as a specific form of pain related to the pelvic girdle in pregnancy, and may occur in conjunction with low back pain in pregnancy [3].

In Norway, this condition accounts for a large proportion of sick leave in pregnancy [2], [5], and a new study of women in the postnatal phase following delivery, found that almost one third were sick-listed in pregnancy due to PGP [2]. The aetiology is unclear, as is the prevalence [3], [6]. Even though PGP has been reported on all continents, it has also been described as a cultural-specific phenomenon, with a higher frequency in Scandinavia than in the rest of the world [6]. PGP has even been termed a fashion disorder as a culturally defined symptom of anxiety and stress [7].

The Norwegian health authorities classify PGP as a common complaint in pregnancy, which in exceptional cases may develop into a disabling condition [3]. The Norwegian patient organisation for women with PGP (LKB), on the other hand, has struggled for acknowledgement of the condition as a medical diagnosis, and for the social rights for the sufferers [8].

The internet is widely used to seek health information or to communicate with others who share a particular problem or diagnosis [9], [10], [11]. In response to women's needs for a forum to discuss their pregnancy-related concerns, a free website “barnimagen” (child in womb) was opened in 2000 [12] that also contains discussions related to PGP [13]. In the introduction to these net discussions on PGP, it is firstly stated that hormonal-induced loosening of the pelvic girdle is a normal physiological preparation for birth that usually is unproblematic. Secondly, it is stated that many women experience discomfort and develop long-lasting pain. Thirdly, women are invited to share their experiences and to meet other women in the same situation [13]. The website “barnimagen” is frequently used by pregnant women in Norway today, and probably represents an important arena for the transmission and exchange of knowledge about pregnancy health and PGP. It is not well known, however, how the discussions on the internet relate to the perspectives of the health authorities and professional health workers.

Using PGP as an empirical entry point, the aim of this paper is to investigate discussions on the internet, and to discuss how these compare with the prevailing official discourse on PGP. This article reports on the findings from the first part of a larger study that aims to explore competing discourses related to pregnancy and pregnancy health, and how these discourses are expressed and challenged in different arenas. The general purpose of the larger study is to understand how pregnancy is culturally and socially constructed in contemporary Norwegian society. The concept “discourse” here refers to a body of language use that is unified by common assumptions, which makes certain things “sayable”, “thinkable” and “doable”, and others not [14].

Approximately 55,000 children are born in Norway every year [3], and this fertility rate is one of the highest in Europe [15]. Pregnant women have access to free antenatal services by a doctor or midwife or both. According to Norwegian policy guidelines, pregnant women are expected to continue working until gestation week 37. Thereafter they are entitled to paid maternity leave that extends to nearly a full year, including leave for the father. Among mothers with children aged 0–2 years, 74% are employed [16], and they remain in the workforce throughout pregnancy. However, little is done at the work place to adjust its conditions to meet the changing needs of a pregnant woman [1], [17] despite a well-documented relationship between job adjustments and reduced sickness absence during pregnancy [17].

In the Norwegian healthcare system pregnancy is treated in an ambiguous manner. On the one hand, an uncomplicated pregnancy is treated as a normal condition by policy makers and pregnancy care professionals. On the other hand, pregnancy, as a heavily medicalised condition, is surrounded by strong risk discourses [18], [19], [20], [21], [22]. The information routinely given to a pregnant woman is based on biomedical knowledge, and much of the advice she receives is directed at containing the risk to her own health, but even more intensely at containing the risk to the health and well-being of the foetus [22].

The official policy on pregnancy health in Norway is expressed in the Norwegian Guidelines for Pregnancy Care from 2005, targeting midwives, doctors and pregnant women. The guidelines state that pregnant women are not sick and should not be considered as sick or be scared unnecessarily [3], but recognise that pregnancy can be experienced as a trying process [3]. Whereas problems like pre-eclampsia, diabetes, pre-term delivery, depression, violence and sexual abuse are discussed under “Clinical problems in pregnancy”, PGP is classified together with constipation, fatigue, varicose veins, leg cramps and nausea under “Common complaints in pregnancy” [3]. The guidelines describe PGP as a discomfort that may prevent women carrying out their daily activities and that may, in the worst case develop into a disabling pain [3]. The information about and advice on treatment for PGP in the Norwegian Guidelines is based on the European Guidelines on the Diagnosis and Treatment of Pelvic Girdle Pain [23]. Information, as part of an intervention, is discussed here. The guidelines state that information, advice and treatment should be consistent across professions so that unnecessary anxiety may be avoided [3], [23]. The importance of taking patient complaints seriously is also underlined [23].

The patient organisation LKB, which was established in 1987, provides information for pregnant women, health-care professionals and the public at large, and works for the provision of support, treatment and remedies to assist women who suffer from PGP [24], [25], [26], [27], [28].

Section snippets

Conceptual framework

Building on a symbolic interactionist perspective [29], [30], this study sees the meaning of illness as the outcome of social processes [30], [31]. The focus is not on the body as a biological entity, or on symptoms manifested in the body, but on the meaning attached to these symptoms. Popular discourses on health and sickness as well as professional discourses are constructed in specific social and cultural contexts where some issues are downplayed or ignored, and others are emphasised. Thus

Results

In the exchange of information between the participants in the internet discussions, some participants appear as inexperienced advice-seekers and others as experienced advice-givers. However, the roles are fluid, and the discussions are in general characterised by equal peer relationships. In the following we will present excerpts from the internet discussions, illustrating how expressions of pain, worry, uncertainty and doubt are met with messages to take care and with warnings of future

“Listen to your body”

The internet discussions presented here create a discourse on PGP as an “unpredictable condition” that emphasises the importance of pregnant women listening to their bodies and taking care of themselves. In this popular discourse the full responsibility for future health and well-being is placed on the woman herself.

An interesting question in this context is whether this discourse can be seen as a reflection of a general need for care and support in pregnancy, as well as a reflection of the

Acknowledgments

Thanks to Norske Kvinners Sanitetsforening (NKS) whose financial support has made this work possible. Thanks also to Janet Harris, associate professor at Bergen University College, for her useful help and advice in the revision process.

References (44)

  • J. Skolbekken

    The risk epidemic in medical journals

    Soc Sci Med

    (1995)
  • Wergeland E, Strand K, Endresen EH. Gravid i Norge ved inngangen til nittiårene. Graviditet og arbeid. [Pregnant in...
  • H.S. Robinson et al.

    Pelvic girdle pain in Pregnancy: the impact on function

    Acta Obstet Gynecol Scand

    (2006)
  • Klovning A, Backe B, Eide BI, Blix E, Aarseth J, Mathiesen MR, Holan S, Roland B. Retningslinjer for...
  • G. Skylv

    Bækkenløsning- sygdom eller afvigelse? [PGP disease or deviation?]

    Stofskifte

    (1988)
  • B. Grunfeld et al.

    Sykdom under svangerskapet. Forbruk av sykemeldinger blant gravide i Oslo. [Illness during pregnancy. The consumption of sick leaves among pregnant women in Oslo]

    Tidsskrift Nor Laegeforen

    (1991)
  • Stuge B. Physical therapy for pregnancy-related pelvic girdle pain. Underlying principles and effect of treatment....
  • C.N.M. Renckens

    Between hysteria and quackery: some reflections on the Dutch epidemic of obstetric “pelvic instability”

    J Psychosom Obstet Gynecol

    (2000)
  • Landsforeningen for Kvinner med Bekkenløsningsplager. LKB gjennom tidene. [The patient organisation for women with PGP....
  • H.K. Andreassen et al.

    Helserelatert bruk av Internett i den norske befolkningen. [Health-related internet use in the Norwegian population]

    Tidsskrift Nor Laegeforen

    (2006)
  • M. Hardey

    Doctor in the house: the internet as a source of lay knowledge and the challenge to expertise

    Sociol Health Illness

    (1999)
  • M. Hardey

    “The Story of My Illness”: personal accounts of illness on the internet

    Health

    (2002)
  • BarniMagen.com [database on the internet] Oslo: Copyright 1997–2007. Baby Media AS. Available from...
  • BarniMagen.com. Bekkenløsning-debatten [The PGP-discussion] [database on the internet] Oslo: Copyright 1997–2007. Baby...
  • N. Abercrombie et al.

    The Penguin Dictionary of Sociology

    (2006)
  • Statistisk Sentralbyrå. Fødsler og barn. Slekters gang [Norwegian official statistics: Births and children. The...
  • Kitterød RH, Kjeldstad R. Strammere tidsklemme? Endringer i mødres og fedres arbeidstid på 1990-tallet [A tighter time...
  • K. Strand et al.

    Job adjustment as a means to reduce sickness absence during pregnancy

    Scand J Work Environ Health

    (1997)
  • D. Lupton

    Risk

    (2006)
  • U. Beck et al.

    The Normal Chaos of Love

    (1995)
  • Lindgren BH. Pregnoscape. Den gravida kroppen som arena for motstridiga perspektiv på risk, køn och medicinsk teknikk...
  • D. Lupton

    Risk and the ontology of pregnant embodiment

  • Cited by (35)

    • Exploring experiences and needs of perinatal women in digital healthcare: A meta-ethnography of qualitative evidence

      2023, International Journal of Medical Informatics
      Citation Excerpt :

      A total of 3,843 articles were identified. A total of 27 studies were selected including 24 published studies [31–54] and 3 unpublished theses [51,55–56]. Substantial agreement was obtained between the raters (κ = 0.82–0.86) for the study selection, quality assessment, and confidence level of the review findings.

    • Pregnancy-Related Pelvic Girdle Pain in Polish and Norwegian Women

      2019, Journal of Manipulative and Physiological Therapeutics
    • A qualitative exploration of the views and experiences of women with Pregnancy related Pelvic Girdle Pain

      2018, Physiotherapy (United Kingdom)
      Citation Excerpt :

      These results suggest women frequently use the NHS website and online forums for information on PPGP. However, a knowledgeable health professional was seen as an important support mechanism, which is observed in previous studies [13,28,29]. Speculatively, if PPGP information was provided in early pregnancy, it could lead to a decrease in anxiety.

    View all citing articles on Scopus
    View full text