Reproductive Losses in the Context of Institutional Interaction: Practices, Spaces and Trajectories of Care

Abstract

Reproductive loss (cases of frozen pregnancy, miscarriage, stillbirth, abortion for medical reasons) is not only bodily and psychological, but also a social phenomenon. Its significance is constructed in numerous interactions of multiple actors (women, medical staff, psychologists, family members), whose interpretations may differ significantly. Pregnancy and birth in Russia are very medicalized, and most women undergo encounters in medical settings while experiencing reproductive loss. However, the representations and practices of care that exist there do not always meet their requests. In recent years Russian maternity care system has gone through a few changes and reforms that have influenced the principles of functioning of medical institutions, their rules and practices. The agents that inhabit medical fields have also changed and turned to a more patient-­centred medicine. In order to lessen the gap between women’s perspectives on care and their experiences in institutional medical environment, in some cases medical staff build individualized care trajectories for their patients. However, they are not stable enough. Eventually, in recent years we can observe gradual and non-linear shift in practices that leads to the emergence of spaces of care. Notwithstanding, the transformation of practices meets barriers caused by mismatch between perspectives of women and professionals. In this article, I consider how the practices of caring for women and the unborn are implemented in medical institutions. I focus on the problematic interactions of women and medical staff in situations of reproductive loss. This article is based on analysis of 26 interviews with women who experienced reproductive loss, 20 interviews with professionals (doctors, midwives, psychologists, doulas, perinatal palliative care specialists), as well as observations in medical institutions and synopsizes of discussions of relevant topics at medical scientific events.