Negotiating the ambiguity of an (in)authentic working life: a grounded theory study into severe perineal trauma

Abstract

Background In Sweden, persistent physical and psychological health problems occur in about three in ten women who sustain severe perineal trauma (SPT) during childbirth. As most Swedish women work outside the home, the question of if and how SPT-related morbidity influences working life needs exploration. This study aims to qualitatively explore how women with persistent SPT-related morbidities experience and conceptualise their problems concerning working life. Further, we theorise the findings by applying Simone de Beauvoir’s feminist framework of immanence and transcendence as well as authentic and inauthentic life. Methods Ten interviews with women recruited via a Swedish social media community for perineal trauma were analysed according to Charmaz’s constructivist approach to grounded theory. Results The theoretical model and related core category ‘Negotiating the ambiguity of an (in)authentic working life’ reflected the women’s negotiations of immanence as ‘the silent covert object’ versus transcendence as the ‘the resourceful overt subject’. The model also mirrored the conflict of (in)authenticity in working life. An inauthentic working life was experienced when women were denied their subjectivity at work or constructed themselves as subjects in denial of their SPT. On the other hand, women who acknowledged their SPT and were constructed as subjects by ‘others’ achieved an authentic working life despite SPT. Conclusions The conflicting gendered process of ‘the silent covert object’ versus ‘the resourceful overt subject’ problematised women’s vulnerability at work. Aspects that enable subjectification and transcendence are essential for policymakers, employers, healthcare services, and society to eradicate the taboo of SPT and create a working environment characterised by understanding, support, and flexibility. Further, access to adequate care, sick leave, and occupational rehabilitation are essential. Such measures support transcendence towards an authentic working life and, consequently, a more gender-equal working environment that does not deprive women of career opportunities due to a physical ailment.

Is Amniotomy a Risk Factor for Severe Perineal Trauma? -A Swedish Nationwide Register Study

“…Severe perineal trauma (SPT) is the most severe form of perineal trauma, affecting 2.5-5.9% of women giving birth (4-6), with a potential for both short-term and long-term consequences (7,8). The morbidity includes both physical and psychological effects such as anal and urinary incontinence, sexual dysfunction, and reduced quality of life (7)(8)(9)(10). The initial classi cation of perineal tears in Sweden is made by the midwife responsible for the birth, who also repairs rst and second degree tears (11).…”

Overlooked by the obstetric gaze – how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study

“…Moreover, women with SPT describe that some HCPs tend to normalise their SPT-related problems [10,[17][18][19][20][21][22], and women are met in unprofessional and disrespectful ways [17,23], where HCPs are perceived as ignorant, nonchalant, and questioning women's symptoms [10,17]. Previous research [24] indicates an institutional objectification of women with SPT by Swedish healthcare providers hindering access to healthcare, sick leave, and occupational rehabilitation after SPT. In contrast, women also report being acknowledged and liberated when HCPs have a professional and empathic approach and provide continuity of care that enables access to care for persistent SPT-related health problems [17][18][19]25].…”