Positioning mattering

“Space, time and matter are mutually constituted through the dynamics of iterative intra-actions” (Barad 2007:181).

These entangled intra-actions seem to be illuminated in Obstetrics.

In a classroom session this week I observed junior students’ representations of the birthing phenomenon in a collection of their free drawings. Their images reflected the controversial topic of positioning in labour, foregrounding widely held beliefs and assumption that mothers give birth from a supine position.

Similarly, a couple of the participants in my research project have centred a bed in their drawings, placing a woman lying in a crook position, as indicated in the image above (drawn on my iPad using the Pastels App). The bed appears as the focal point for the birthing process and associated procedures.

Yet there is evidence to suggest that mobility and alternative positioning facilitates the birthing process. However the bed remains an important apparatus especially with the medicalization of labour where regular monitoring of the foetal heart is prioritized. It is easier to manage this and other measurements when women are horizontal.

The choice of positioning in labour remains contested as a result of many influences. There are conflicting views in terms of mobility during the different phases of labour. What I hear from my midwifery colleagues is that walking, sitting and finding alternative positions is preferable for the health of the foetus and the mother. An innovative initiative in Peru has shifted practices in maternal healthcare to accommodate cultural beliefs. This has led to a significant drop in maternal mortality rates. Previously, when the horizontal position was forced onto women in labour, the indigenous women chose to stay at home for their birthing experiences despite the many associated risks particularly in rural areas. In their homes, these women could adhere to their cultural tradition of vertical positioning without the fear of opposing forces at public health facilities.  Since the Health Ministry in Peru adopted new policies that facilitate alternative positioning, more women are attending the facilities resulting in reduced mortality rates - a valued move in governmental support towards health promotion and respect for women’s rights. http://its.uvm.edu/Vertical%20Birth/Vertical%20Birth.html

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of matter and meaning. Durham, NC: Duke University Press.

Time for tea

“We must make matter matter, not only in science but in society as well”

(Hekman, 2008:116)

As I look into the folds of practice where students are learning about/for Obstetrics, small matters that seem insignificant do become relevant, demonstrating material agency in their entanglements and inter-relationalities. One such example is the cup of tea/coffee.

Barad (2007:390) states that

“We are responsible for the world of which we are a part, not because it is an arbitrary construction of our choosing but because reality is sedimented out of particular practices that we have a role in shaping and through which we are shaped”.

Near the start of my interest in this work, a student mentioned how special it was to be invited into the nurses’ tearoom for a cup of tea during her Obstetrics rotation. This action/intra-action seemed to break into/through disciplinary and power differences thereby enabling this student to feel welcomed into a space that was traditionally seen as a “no space” for students. Shared tea in a communal space became an affirmative action towards developing mutual responsibility in teaching and learning. There was a reconstitution of a boundary.

In a  learning brief produced by the Perinatal Mental Health Project, based in Cape Town, there is a recommendation for health workers to find time for tea and to “step outside for your tea break” as a self-care strategy.

But what happens when tea time and drinking tea/coffee has more force and power than the needs of women in labour? Barad (2007:390) calls for a posthumanist ethics in terms of responsibility which she asserts “is the ability to respond to the other”. To explore an understanding of the material-discursive practices that do occur in Obstetrics, the phenomenon of tea/coffee drinking can be helpful. Besides the establishment of social relations, there are detrimental consequences when the drinking of tea overrides the necessity to provide care when it is needed. The material arrangements in facilities seem to contribute to such choices when the dynamic interplay of the cup and the health worker takes preference and therefore  excludes other intra-actions, constituting “changing conditions of possibility of changing possibilities” (Barad 2007:179).

The image above (drawn on my iPad using the Draw App then Adobe Ideas) reflects Barad’s (2007:181) metaphor of the tree rings - “evocative of the sedimenting process of becoming”. The past is always present with us. What students witness and experience in their training continues to impact on their future practice as a doctor. The drawing also reminds me of contour paths representing the iterative process of becoming, with different gradients and intensities. Pickering (1995:113) points out that “the contours of material agency emerge only in practice”.

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of

matter and meaning. Durham, NC: Duke University Press.

Hekman, S. J.. 2008. Constructing the Ballast: An ontology for feminism.  In S. Alaimo & S. J. Hekman (Eds.), Material Feminisms (pp 85-119). Indiana University Press. Bloomington.

Perinatal Mental Health Project. 2013. Caring for health workers. Learning brief. http://pmhp.za.org/wp-content/uploads/2015/01/Leaflet_HealthWorkers.pdf

Pickering, A. 1995. The Mangle of Practice: Time, Agency, and Science. University of Chicago Press.

Me and my iPad

“Bodies assemble and disassemble as they are machined through desire” (Clark 2012:210).

Desire is expressed by Clark (2012:202) in an affirmative way as the “magnetic attraction between bodies”. My iPad is a vital part/extension of me. When I use the potentials and engage with the affordances of the tablet (especially in terms of drawing) then the creative ‘artwork’ appears to open up my thinking through theory and practice. This communication seems to generate flows of intensity and affective entanglements.

I recognize the formation of an assemblage in/between myself and the tablet, towards a plane of consistency (Deleuze & Guattari 1987). This creative encounter enables me to be sensitive to the forces and flows through their mutual intelligibility (Barad 2007). The concept of a Body without Organs (BwO) is helpful in terms of the distribution of intensities, through the taking away of obstructions (Deleuze & Guattari 2987). It indicates an ideal limit that is unreachable. Yet the potential multiplicities and ambiguities provide a positive flow beyond blockage points and nodes of disruption.

There are two phases in the construction of a BwO, named by Clark (2012) as experimentation and becoming (Deleuze & Guattari 1987). The former explains the process of “finding pieces with which to connect and experiment” (2012:203). My drawings are spontaneous and free. I do not plan them or predict what they will look like. They are generated as I think through/with the materiality of the tablet, any time, any place. There appears to be a dual flow of affect through the fabrication of imagining images.

In the latter phase, my becoming, the process facilitates my action “to make something circulate on it or pass across it” (Deleuze & Guattari 1987:152). Through the relationship of my iPad and me, there is an energy that opens up the in-between space (Clark 2012). This experience becomes a movement that is a force in my becoming.which is open to new possibilities.

The image above (drawn on my iPad using the Brushes App) attempts to illustrate the disarticulation apparently happening in the generated assemblage. The unanticipated flows of intensities prevail as I explore art and images through visual text. There appears to be “freeing lines of flight, causing conjugated flows to pass and escape and bringing forth continuous intensities for a BwO” … with a  “connection of desires, conjunction of flows, continuum of intensities” (Deleuze & Guattari 1987:161). This production of a minoritarian assemblage resembling my becoming-researcher, becoming-art-creator, becoming-iPad contrasts with the established majoritarian assemblages that foreground binaries such as self/other and researcher/data (Clark 2012). As the process moves forward, I look forward to gaining a deeper understanding of these elements.

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of

matter and meaning. Durham, NC: Duke University Press.

Clark, V. 2012. Art practice as possible worlds. International Journal of Child, Youth and Family Studies (2012) 2 & 3: 198–213.

Deleuze, G., & Guattari. F. 1987. A thousand plateaus: Capitalism and schizophrenia.

Trans. B. Massumi. Minneapolis, MN: University of Minnesota Press.

Citing circles

Vicious circles of abuse, concentric circles of influence, life circles of identities combine with spirals of learning. These relationships mesh in/through/to spheres in uncertain ways. There are blurring lines between the circles and spirals as they move in/between each other. My research and teaching is cutting in/to a moment in student learning - a blob/node in the curriculum that acts with intensity, through affect, to effect the becoming doctor, often a lifetime. Conversations with doctors who have many years of experience indicate how Obstetrics changed them, stained them and remained with them - a memory/mark.

In the image above (created on my iPad using Sketches), I crack a peephole into my teaching experiences. This takes me along lines that touch/feel/see and explore students’ learning experiences. The darkness of this peephole is illuminated by the impact of sharing.

When I draw on students’ personal learning experiences from incidents in their Obstetrics rotation, I encourage them to engage in meaningful dialogue with their clinical partners who become their critical friends. Students voice their insights and their narratives to/with each other. There appear to be overlapping circles that are shifting darkness into light.  Feedback indicates the positive responses as perspectives are changed and expanded. There is a refocus, like the changing lenses used by Ophthalmologists, sliding/slipping between/in/through each other to improve our vision, enhancing self-evaluation and open-mindedness (Costas & Kallick 1993).

Costa, A. & Kallick, B.1993. Through the Lens of a Critical Friend, Educational Leadership 51:2: 49–51.

http://www.ascd.org/publications/educational-leadership/oct93/vol51/num02/Through-the-Lens-of-a-Critical-Friend.aspx