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Abstract
This dissertation examines the hospital management of perinatal death during the last half of the twentieth century in Canada and shows that beginning in the mid-1980s, a new standard of care emerged for women experiencing perinatal death. The new standard of care recognized perinatal death as loss that women grieve and that requires compassionate care. Asking why and how perinatal loss came to be recognized in hospitals, this qualitative case study employs a hybrid of feminist, auto/biographical, and grounded methodologies. Data collection included interviews with 35 nurses, physicians, chaplains, social workers, and maternal health advocates who were key actors in the shift to a new standard of care. Key historical documents were also reviewed. I argue that this shift to the new standard of care was conditioned by changing social attitudes towards death and grief, from modernist silence to neo-modern expressivity, and by greater technological and medical specialization. At the level of social interaction, the new standard of care was initiated through local innovation by a subset of health care providers. Using a mesodomain symbolic interactionist analysis, this dissertation introduces new or revised concepts to explain local hospital innovation for perinatal loss: sentinel experience, emotional labour, critical mass, and griefwork. Sentinel experiences sensitized key actors to a need for change as they repositioned themselves between women and technology to learn women's needs. Emotional labour theorizes how caregivers managed their own and others' emotions. I argue that emotional labour was a determinant of institutional change. Critical mass conceptualizes the emergence of a collective actor promoting institutional change in the hospital. Griefwork, the central conceptual contribution of this thesis, analyzes grief in symbolic interactionist terms as labour shared and negotiated between grieving women and caregivers. This work is of interest to researchers examining social practices around death, particularly perinatal death, and maternal health. It is relevant to the sociology of health and illness, feminist methodology, and symbolic interactionism. It is also of value to professional caregivers who are interested in advocacy and social change.
