Abstract
This article focuses on referential practices at a Japanese midwife house, where at prenatal examinations, a midwife palpates a pregnant woman’s abdomen with her hands, without any assistance from an ultrasound scanner. The midwife often refers to spots on the abdomen in palpation with locative demonstrative expressions. I demonstrate that ways in which references to spots on the pregnant woman’s abdomen are accomplished are subtly different, depending on the action sequence in which they are embedded. The description of referential practices in which the touching plays an important role has consequences for the re-conceptualization of human interaction in general, and interaction between medical professionals and their clients in modern medical settings in particular.
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Notes
All the parties to the interaction to be analyzed in what follows use the term “baby” (“akachan”) consistently. Accordingly, I will use the term throughout this article to refer to the fetus.
This study is part of a larger body of research currently underway, concerning ways in which women experience the encounter with medical professionals, their own bodies, fetuses, and the like, in Japanese obstetric and gynecological (OB/GYN) settings, clinics or midwife houses. My colleagues and I have videotaped about 60 visits at four OB/GYN clinics, at the OB/GYN division at four hospitals and three midwife houses (including about 35 clients, pregnant women or other types of “patients”). OB/GYN occupies a central position in our society in the sense that not only do most people have to be involved with it at least once at the very beginning of their lifetime but also it is the field which has been providing highly advanced medical technologies, such as genetic engineering, with crucial resources and, in turn, advanced technologies of various kinds have been applied intently to OB/GYN, to treat infertility, to practice prenatal examinations, and the like. We thought that it is very important to register what both medical professionals (doctors, midwives, nurses, and the like) and their clients (pregnant women, women with gynecological complaints, and the like) experience and perceive actually in the technological environment of OB/GYN settings, precisely because various aspects of women’s lives are involved (for empirical researches that aim at it, for example, see Banks 1999, for the history of birth chairs; Franklin 1997, for assisted conception; Jordan 1993, for midwifery; Lock 1993, for menopause; Rapp 1999, for amniocentesis; and Tsuge 1999, for infertility; see also Martin 1989, for a general discussion based on analyses of various texts and discourses related to childbirth). One of the purposes of the entire research project is to pursue the detailed description of experience and perception by parties to OB/GYN settings through the analysis of videotaped actual encounters between them.
Leopold’s maneuvers are employed to determine the lie of an unborn baby, consisting of four maneuvers: (1) determination of what fetal part is at the uterine fundus (see Fig. 1), (2) evaluation of the fetal back and extremities, (3) determination of what fetal part is above the pubic symphysis, and (4) evaluation of the fetal presentation.
All the excerpts cited in this article are composed of three parts: At each numbered line, there is a romanized original Japanese transcript, and below this are phrase-by-phrase glosses. Finally a rough English translation is added after each turn. Those Japanese words, which are focused on in the discussion in the text are made bold. In the original transcript a transcription system developed by Gail Jefferson is used (see Jefferson 2004, for its most recent version). In phrase-by-phrase glosses the following abbreviations are used:
JD Judgmental
P Particle
Expressions “koko” and “kocchi” are different subtly from each other, of course. “koko” means more straightforwardly “here,” a location in the speaker’s vicinity. “kocchi,” on the other hand, highlights a contrast of the designated location to another location or thing. In the case at hand, the location designated as “koko“ at 02 has been established as a base, in contrast to which another location is designated with the expression “kocchi.” The use here of “kocchi” is orderly with respect to the current activity the parties engage in. The spatial relation of these two localities is crucial for an attempt to demonstrate the normal arrangement of the baby’s body parts. I will later return to the organization of this activity of theirs.
We, native Japanese speakers, hear that both “de” and “'nde” are abbreviated forms of “sorede [and then].”
The relationship in which visual impressions, visual images, electric pulses in the nervous systems and so on, represent the object being seen must not always be relevant, contrary to the cognitivist assumption about vision and other mental phenomena. I do not deny that some visual images, electric pulses, or the like, may represent something on some occasions. However, the representational relationship between those images, electric pulses, etc. and the objects represented by them makes sense only on specific occasions, such as the one that we examined in the text (another occasion may be a psychological experiment; see Nishizaka 2000). Moreover, when the representational relationship between two things is relevant, one directly (without any intermediate representations) perceives or experiences the representational structures in the same way in which one directly perceives a book, a computer, etc., on my desk.
Note that they appear to be oriented to the student’s touching hand as well as the touched object, not to the student’s touched hand, namely, her hand as touched by the midwife’s hand.
Schegloff (1998) describes the consequences of the distribution of orientations exhibited by distinct body parts, particularly, what he calls “body torque,” to the actual development of interaction. For the normative structure of the body, see also Goffman’s (1971) discussion on “the territories of the self.” Particularly, his observations about what he calls “personal space,” namely, the surrounding space of an individual within which “an entering other causes the individual to feel encroached upon” (p. 29), are relevant here. He observes, for example, that the spatial demands directly in front of the face are larger than at back. My argument is that this difference in the spatial demands is related to the normative expectation as to how differently an individual’s distinct body parts exhibit his or her orientations.
For example, ko-prefixed terms include “kore” (this) and “kono X” (this X), besides “koko” and “koochi” (this place). Japanese also has a-prefixed deictic terms, referring to things and places in the distance from both the speaker and the recipient, and so-prefixed deictic terms, referring to the recipient’s vicinities. These terms include “are” (that), “ano X” (that X), “asoko” (that place) and the like, and “sore” (that), “sono X” (that X), “soko” (that place) and the like.
In Excerpt 2 the parties, the midwife and the student, are jointly oriented to spots on the client’s abdomen in a similar way to Excerpt 1, but it should be noted that the midwife positions herself diagonally behind the student such that she shows her orientation to the (operations of the) student as well as the client’s abdomen (see Fig. 2). Moreover, when the midwife resettled herself to make room for the student who was going to occupy the right position for palpation, she sat with her entire body oriented to the client’s abdomen, without any twist of her body. It should be easy to see that this rearrangement of the midwife’s and the student’s bodies is specifically relevant to the instructional context.
The midwife’s utterance at 06 is also hearable as embedded in a question initiated at 01. The client’s response at 07 is, therefore, hearable as a response to the question “do you recognize (that) here is the back?” In this light, the midwife’s remark at 08, the closing part of the demonstration sequence, can be said to terminate the government of the question context produced at 01.
Goodwin (2000) speaks of “different kinds of semiotic resources” simultaneously deployed for human actions to be built, focusing on the constitution of action through the juxtaposition of talk, gesture and structure in the environment. His demonstration is relevant here. My focus in this article has been on multi-sensory structuring of the environment, particularly, pregnant women’s body, in conjunction with talk and hand movements.
Palpation by physicians, particularly palpating a woman’s body by a male physician, was very rare in the 18th century. I will return to this very shortly.
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Acknowledgments
I am very grateful to George Psathas for his encouragement and valuable comments on an earlier version of this article. Dom Berducci read through several versions of the manuscript and provided many helpful comments.
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This article is based on the presentation at the 2005 International Institute for Ethnomethodology and Conversation Analysis Conference in Waltham, USA. I benefited from many of the useful comments and suggestions provided there.
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Nishizaka, A. Hand Touching Hand: Referential Practice at a Japanese Midwife House. Hum Stud 30, 199–217 (2007). https://doi.org/10.1007/s10746-007-9059-4
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DOI: https://doi.org/10.1007/s10746-007-9059-4