Book review

Therapeutic arts in pregnancy, birth and new parenthood, edited by Susan Hogan

Routledge, Abingdon and New York, 2021 
ISBN 978-0-367-46224-7

Reviewed by Sasha Iyengar

“How do we tell the story of who we are, even to ourselves?” (Hardstaff, p.107)

As I turn the pages of this book, the fragile beginnings of my second pregnancy unfold – in the midst of another lockdown in Auckland, New Zealand. Boundaries, the contours of my identity, again begin to shift. 

Therapeutic arts in pregnancy, birth and new parenthood contains a diverse and thought-provoking collection of practice and research within the therapeutic arts. Contributions span the globe and have been well curated to provide insightful and dynamic perspectives on this significant and relatively under-researched area of practice.

The book’s structure follows a linear narrative of what might be deemed ‘developmental stages’ – flowing from the use of therapeutic arts during conception to pregnancy, through to birth and the postnatal period. However, what is both engaging and nuanced is that the path through its pages is divergent through its inclusion of perspectives that challenge, dismantle and interrogate the social discourse of mothering and new parenthood. 

The personal and professional intertwine across many chapters, with authors linking personal anecdotes of pregnancy, birth and new parenthood with clinical practice. In many cases these life experiences motivate the drive to pursue research and therapeutic arts practice in these areas, and provide a rich catalyst for creative and psychosocial investigation. What I find most poignant across the breadth of material is the clear demonstration of therapeutic arts providing a space for empowerment through the expression of stories – shifting ownership of these narratives back to the individuals who live them.

The initial chapters trace the painful realities of infertility, pregnancy fear, reproductive trauma and perinatal loss. The use of metaphor to process and express grief and loss lies at the heart of this work. Sue Bulmer shares an arts-based heuristic enquiry of her own artwork, emerging from her personal, lived experience. She explores the loss and grief of her own infertility through a variety of expressive forms, reflecting the development of “kinesthetic consciousness” (p.18) through movement and tactile engagement within the creative process.
The emergence of three-dimensional vessels resonates between the therapeutic work of Bulmer and Laura Seftel, metaphorically symbolising the womb and a tangible container for grief. Seftel dissolves the stigma and silence of pregnancy loss through digital community exhibitions in which hidden stories of pregnancy loss are shared. “When artists reveal their personal narratives of grief... they wake us up and open our hearts” (p.40). 

Helén Wahlbeck navigates severe fear in late pregnancy in a maternal healthcare setting in the south of Sweden. Body mapping is used with her patients to investigate the experience of fear, map control in the body and facilitate attachment. Claire Flahavan further strengthens the therapeutic value of metaphor with people who have experienced pregnancy loss. Intangible, unravelling grief is able to be captured within visual landscapes that situate this loss within a symbolic time and place, thereby supporting those suffering to “‘walk back into themselves’, so that they can anchor the experience of loss” (p.60).

The institution of ‘motherhood’ is deconstructed across the subsequent chapters, where authors call for redefinitions; they advocate that engagement with the therapeutic arts allows for the construction of new self-narratives. Sheridan Linnell and Asha Zappa scratch back the surface to disrupt linear narratives by describing the process of pregnancy, birth and (m)othering as inherently queer. Their powerful advocacy for the shift of ‘mother’ from noun to verb (p.171) directly exposes and challenges gender normative assumptions, so often inherent in therapeutic practice. This is significant in calling upon the arts therapist to understand that the female body and identity are not synonymous, making space for the identities of trans and/or gender independent parents. Motherhood as a ‘developmental aspiration’ is challenged and art therapy’s potential to play a powerful role in the co-construction of new symbolic representations of parenting and motherhood is highlighted by Lucia Hervás Hermida.

Amy Lockhart Chilton uses the photographic arts as a powerful tool to reframe the experience of motherhood. She promotes ‘matrescence’ as a term that better captures the complexity of motherhood, by situating it on a continuum. Jane Hardstaff, through her own art practice, becomes aware of “boundaries shifting, realigning, disintegrating” (p.109). Marián López Fernández-Cao traces the representation of motherhood across art and religious history, where symbolic and cultural portrayal are constrained by the patriarchy. Here, pregnant and birthing bodies fall under tight censorship. Today, the commercialisation of motherhood further disenfranchises women, departing from the reality of lived experience. 

Although childbirth is a universal experience, it is also culturally mediated – it is experienced through culture (Hogan, p.1). This book contains meaningful contributions from the use of therapeutic arts within marginalised and multicultural communities. Heather Tuffery shares therapeutic cross-cultural group work with new mothers experiencing domestic violence. Daniela Besa Torrealba writes from Chile, exposing gender-based obstetric violence as experienced through the stories and artwork of three women working in the health sector. Diane Bruce discusses the use of art psychotherapy within perinatal parent–infant work with migrants who have experienced interrelational and emotional trauma.

The processes of pregnancy, birthing and new parenthood, while distinctly human, have become dislocated and highly political. “Art therapists are well positioned to find artful ways to challenge conventional notions and complex intersections of gender, sexuality, pregnancy, birth and mothering” (Linnell & Zappa, p.172). An individual survives by re-authoring their own maternal or parenting narrative – whether it be a story of isolation, domesticity, trauma or oppression. Creative engagement alongside a therapist goes a long
way in supporting this process. 

An implicit message throughout this book is for the arts therapist to normalise the state of ambivalence in pregnancy, birth and new parenthood – it is both, it is all. The grand narrative of motherhood undermines the complexity of the mixed feelings and contradictory states experienced by these identities in transition. Motherhood and family life can be a place for both love and oppression (Hervás Hermida, p.246). Supporting the people we work with to hold contradictory states and accept them as part of human experience is fundamental to work in these areas. 

A question surfaces within me as I finish reading – where are the risk factors perceived to be located for these vulnerable groups of people? Those practising and writing through a psychodynamic lens within institutions and healthcare settings acknowledge the complexities with mental health in pregnancy, birth and new parenthood; however, the rhetoric of pathology is ubiquitous in these settings. More often than not, risk factors are situated within the individual. In doing so, the boundary of a fixed identity is inadvertently reinforced, fitting maternal experience into a grand narrative backed by developmental theory. There are risks here of neglecting to make visible the complex threads that make up these experiences. 

The global Covid-19 crisis has generated a particular set of conditions that have greatly impacted the way pregnancy, birth and parenthood are experienced. I myself have only known these experiences to be measured in a pandemic time zone. The promises of a village and human connection are withdrawn, and isolation and trauma are exacerbated as a pregnant or birthing person finds themselves alone at obstetric scans, and often in hospital surrounded by the cold, clinical presence of staff in protective gear – touch mediated and smiles of comfort concealed behind masks. In future editions, it would be interesting to include examples of therapeutic arts practice and research emerging during this strange time. 

This book is both relevant and valuable – capturing the multidimensional contemporary realities of pregnancy, birth and new parenthood. I highly recommend it as a resource for all those working therapeutically with these populations across a multitude of settings.