Women's Studies International Forum 31 (2008) 278–284

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Women's Studies International Forum

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A technology of care: Caregiver response to perinatal loss

Deborah DavidsonYork University, Toronto, Ontario, Canada

a r t i c l e i n f o

0277-5395/$ – see front matter © 2008 Elsevier Ltd.doi:10.1016/j.wsif.2008.05.009

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Available online 3 July 2008

Highly technologized care of pregnancy and childbirth, both lauded and vilified, has also seeded acountermovement of high-touch perinatal care. Employing a feminist symbolic interactionistaccount, this article examines the relationship between high technology and caregiver response inthe high-touch care of dying or dead babies and the grief experienced by theirmothers. Recognizingthe distancing effects technology has on both caregiver–patient and mother–baby relationships,caregivers engaged in a countermovementof high-touch and thus repositioned themselves closer towomen'sexperienceswhere theywerebetter able tomeetwomen's needs.Whentechnologybringsunfavourable consequences humans can, in their innovation and concern for others, repositionthemselves in relation to technology, thereby modifying those unfavourable consequences.

© 2008 Elsevier Ltd. All rights reserved.

While pregnancy and childbirth have had long history ofmedical intervention (Mitchinson, 2002; Rothman, 1987), the1960s and 1970s saw the rapid development of a culture of hightechnology, which grewalongwithmedical specializations suchas neonatology and perinatology (Department of Pediatrics,2005; Neonatology on the Web, 2007; World Association ofPerinatal Medicine, 2005). Now the norm, technology-intensivechildbirth includes such routine procedures as electronic fetalmonitoring, intravenous drip, artificial rupture of membranes,and drugs to strengthen contractions (Morantz & Torrey, 2003).Furthermore, if the life of her baby is at risk, a birthing womanmay be an indirect subject of high technologies that oftendistance mother from child (Anspach, 2003; Lawson, 2002).

With the institutionalization of hospital childbirth in themid-twentieth century, perinatal mortality became a hospitalconcern rather than a private matter occurring in the home. Itis estimated that 20% to 30% of all pregnancies, in the UnitedStates for example, end in loss (Malacrida, 1999, p. 505). Withdevelopments in perinatology and neonatology in the pastfew decades, babies born at earlier gestational periods areconsidered viable, or capable of survival outside of the womb.Some of these very immature babies survive birth only to dieshortly thereafter (Anspach, 2003; Lawson, 2002). The hightechnologies used to prolong or prevent such deaths are alsolikely to distance mother from baby (Lawson, 2002).

Within this technology-intense culture, prior to the pro-found changes that began in the 1980s, when newborns were

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born dead or at risk, women were heavily sedated to preventinteraction with attending caregivers or their babies, andimmediate reaction to their babies' deaths (Sudnow, 1967).When weak or sickly babies did survive, however briefly, andevenwhen theywere expected to die, theywould diewith theirbodies attached tomachines rather than in their mothers' arms(Klaus & Kennell, 1976).

Prior to the mid-1980s, the medical management ofperinatal loss, understood here as miscarriage, neonataldeath, stillbirth, and therapeutic abortion (Health Canada,2000, p. 8.5), was concerned with mortality rates (Weir, 2006)rather than with grief experienced by women. The experienceof perinatal losswas generally understood as best left forgotten.This model of care was concerned with the mechanical body,and caregivers attended to physical needs with little under-standing of or attention to women's social-emotional needs.Technology was left unmediated by any appreciable depth ofhuman interaction. Womenwere hastily and unceremoniouslyseparated from their dying or dead babies and told such thingsas “Forget about this”, and “You're young enough to haveanother child” (Peppers & Knapp, 1980, p. 94).

Though women were told to forget, they would not. Theywould go on to grieve in silence and in isolation (Davidson,1995; Layne, 1990, 1992, 1997; Letherby, 1993; Malacrida,1999; Simonds & Rothman, 1992). Beginning in the early tomid-1980s some health care professionals in the West beganto challenge this institutional dismissal of perinatal loss, and

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by the late twentieth century a profound shift in theguidelines for the care of women experiencing perinatal losshad occurred in hospitals. In the larger research project fromwhich this study is drawn1 it is apparent that in Ontario,Canada this shift emerged in three overlapping stagesbetween the early 1980s and the late 1990s: first with therecognition of a need for change by individuals acting on theirown, then through small affinity groups, and finally throughthe teamwork of collective action.

The new standard of care that developed is set out inprotocols that direct caregivers not only to recognize the“emotional impact of perinatal loss” but also to provide “[a]ppropriate support for the grieving process” (Health Canada,2000, p. 8.5). This recognition and response includes inter-ventions to provide information about grief, care and serviceoptions, and to support and facilitate grief (Health Canada,2000), such as by listening to women, and allowing—evenencouraging—women to see, hold, and name their babies.Photographs and other mementoes are provided, serviceshonouring deceased babies are held in hospitals, and follow-up care is offered. As health care interventions, protocols forperinatal loss are of three types: supportive, informational,and facilitative. The focus of supportive interventions is “onreassuring parents that their expressions of grief areencouraged and accepted—no matter the form” (HealthCanada, 2000, p. 8.12). Informational interventions provideinformation about grief and about “burial and cremationprocedures, memorial services, legal requirements, hospitalregulations, and community services including bereavedparent support groups”; facilitative interventions “are direc-ted at making loss real, coordinating care, helping familiesnavigate the legal requirements, and helping them preparefor the future” (Health Canada, 2000, p. 8.12).

The aim of this article is to demonstrate how, inrecognizing the distancing effects technology had on bothcaregiver–patient and mother–baby relationships, caregiverscame closer to women's experiences of loss where they werebetter able to meet women's needs. They did so through‘high-touch’ care, which is compassionate care that involvesattending to women's social–emotional needs in the biome-dical high-tech arena of the hospital. It involves not arejection of high-tech care, but mediation between hightechnology and social–emotional need. Accordingly, in thisarticle I argue that, when the use of technology leads tounfavourable consequences, humans can, in their compassionfor others, reposition themselves innovatively in relation totechnology, thereby modifying those unfavourable conse-quences. The following discussion briefly sets out the keyconcepts and historical context of “high-touch care” and“technologies of care”, then gives a brief explanation of thetheoretical context and methods of the study, beforeproceeding to a discussion of findings around the themes ofemotional labour, theories of care, interactionwith and care ofothers and changing feeling rules.

High-touch care

In their discussion of technology in High tech high-touch:Technology and our search for meaning (Naisbitt, Naisbitt, &Philips, 1999), the authors discuss the concept of “high-touch”as both a response and a contrast to, and in some ways a

collaboration with, “high tech”. High-touch care, as I treat ithere, is the emotional labour of human response and socialinteraction that mediates dehumanizing consequences ofmedical technology. In this article, high-touch care isexemplified by hospital caregivers who engaged with griev-ing women by being with them, listening to them, andfacilitating their grief.

A technology of care in high-tech times

In this article I use the term “technology of care” in relationto an organised formof human activity, “technology as practice,about the organization of work and people” (Franklin, 1999,p. 2), as “activity” based on “what people know” (Howell,1995,p. 7), and as an interrelationship between high technology andhuman need (Naisbitt et al., 1999).

Regardless of the fact that technology is “manmade” andsubject to the intent and control of humans, it is often seen asmalevolent. Technology is often conceived of and discussed asbeing different from or apart from human interaction, or asmediating interaction, or even as isolationist: as separating usfrom one another (Howell, 1995; Naisbitt et al., 1999; Vega &Brennan, 2000). Medical technology, as high tech, is generallyconceptualized in a narrow sense “in terms of machines thatwere used directly on or around patients” (Howell, 1995, p. 7).Questions posed from scientific and medicalized standpointsoften find answers in technological innovation. It has beenargued that we have been “intoxicated by technology … butits intoxification is squeezing out our human spirit, intensify-ing our search for meaning” (Naisbitt et al., 1999, p. 1). Onesymptom of this high tech intoxification is living “our livesdistanced and distracted” (Naisbitt et al., 1999, p. 20). Inresponse, Naisbitt et al. (1999, p. 26)s describe living high techhigh-touch as “learning how to live as human beings in atechnologically dominated time. It is recognizing when toavoid the layers of distractions and distance technologyaffords us”.

Franklin argues that technology has been used to manip-ulate and control, and to reduce human interaction. She saysthat technology can distort, reduce, or eliminated “recipro-city”, as “some manner of interactive give and take, a genuinecommunication among interacting parties” (Franklin, 1999,p. 42). In the context of perinatal death, when physicianssedated women whose babies were dead or dying, theyeliminated communication with birthing women by render-ing them unconscious. Physicians used sedation as a techno-logical device to distance themselves from the women, toeliminate “face-to-face discussion” between themselves andthe women (Franklin, 1999, p. 42). Such a loss of reciprocity,says Franklin (1999, p. 43), is a “form of technogically executedinequality”. But Franklin (1999, p.46) also argues against theinherent inevitability of a “reduction of meaningful humancontact and reciprocal response”. Franklin (1999, p. 125)claims that the “redemption of technology” “can only comefrom changes inwhat people, individually and collectively, door refrain from doing”. In the following analysis I provide anexample of the redemption of high medical technologythrough a high-touch technology of care. This has beenaccomplished through the actions and interactions of inno-vative caregivers in response to the social–emotional needs ofwomen grieving perinatal loss.

280 D. Davidson / Women's Studies International Forum 31 (2008) 278–284

A feminist symbolic interactionist framework is usedbecause it is an approach that recognises and affirms thatthe ‘lives of women are important’ (Rothman, 1987, p. 239),and that social action is organized on the basis of meaning,which arises from social interaction, and it is through aninterpretative process that we understand and modify thesemeanings (Sandstrom, Martin, & Fine, 2003).

Method

Data collection for the empirical research included inter-views and review of Government and hospital documentsas primary sources. Between late 2003 and early 2005 Iconducted 35 open-ended, semi-structured interviews withkey actors involved in the development and maintenance ofhospital protocols for perinatal bereavement. Interviews weretranscribed and, consistent with grounded theory methodol-ogy, open, axial, and selective coding strategies (Babchuk,1996) were used in the analysis of the empirical research.These participants were innovators in the development of theprotocols in several hospitals in Ontario, Canada, especiallyin the Greater Toronto Area. Participants included nurses invarious positions including direct patient care and adminis-tration, chaplains, social workers, physicians, a consumerhealth advocate, and lay persons involved in perinatalbereavement groups. Some of the participants were alsoinvolved in institutionalizing the protocols at a national level.Of the 35 participants, four were physicians (two female andtwo male), 19 were nurses (all female), two were socialworkers (both female), six were chaplains (four female andtwomale), and two of the four bereaved mothers interviewedalso had nursing backgrounds.

Additionally, I reviewed all four editions of Family-centredmaternity and newborn care: National guidelines (CanadaDepartment of National Health andWelfare, 1968, 1975, 1987;Health Canada, 2000), and policy and procedure materialsconcerning the protocols.

Results and discussion

Emotional labour

Because we are shocked by the emotional turmoil ofanother, we are discomforted … so we try to do some-thing. (Chaplain, participant #20)

James (1992) has described the organizational, physical, andemotional components of caring in health care settings.Following Hochschild's (2003) discussion of emotional labouras workers' management of their own and others' emotions,James (1992, p.500) further describes emotional labour asbeing about “action and reaction, doing and being”, and sinceit is a personal exchange, “it could be argued that it dependson ‘caring about’ before it can be effective”. The statementabove from a participant in my research indicates that he andhis colleagues “cared about” women in grief. As they movedcloser to women and their experiences they recognized “theemotional turmoil of another”, so they began “to try to dosomething” for the women in their care.

Prior to the formation of the bereavement protocols, theinteractional setting in which perinatal death occurred

provided for limited interaction and promoted the dismissivepractices of separating mother from child and silencingwomen's experiences. During the formation of the protocolsthe interactional setting began to open up as key actorsrecognized a need for, and established ways to, increase theinteraction between mother and her dying or dead child andbetween mother and caregivers. This occurred in the contextof an intensification of technology where caregivers counter-acted the high tech movement by increasing their high-touch,or social–emotional, interventions.

Ironically—or perhaps not—it was often those who wereclosest to high-tech carewhowere teachers and leaders in therepositioning of caregivers to high-touch care. It was amongnurses, physicians, chaplains, and social workers in High RiskMaternity and Neonatal Intensive Care Units, those closest tohigh tech, that a leadership group to initiate the high-touchhospital protocols formed. In the following statement from akey actor in the formation of the bereavement protocols,we see his repositioning closer to the experience of grief inperinatal loss, and we see the repositioning of mothers closerto their babies that I argue is pivotal to the changes in thestandard of care for perinatal loss. As the participant noted:

We were all in training, really, as neonatologists, becausethis was a new specialty, so I could offer skilled care forthe newborns … It was about in 1975 that I started to dosomething for the parents of the little ones who died whoI'd been looking after. This involved … taking [dying]babies out of incubators and off ventilators and lettingparents hold them. (Physician, participant #8)

In the development of the bereavement protocols, boththe interaction involved and the character of grief shifted.Interaction both between caregivers and the women andamong caregivers increased significantly, and women's griefbecame work shared with caregivers and the grievingwomen. The bereavement protocols now provide the “richopportunities to contemplate loss” that Lofland (1985, p. 181)notes is a component in the contemporary emotionalexperience of grief. Increased interaction and attention tosocial–emotional needs is accompanied by an increase inemotional labour by caregivers.

Theories of care

Caring in medical work is a complex task (Willis et al.,2005). The theory of human caring, developed by Watson(2006) in the mid- to late 1970s, became highly influentialin the practice of nursing, and describes and validates whatcaregivers see as compassionate care. In an email thatfollowed an in-person interview for my research on theemergence of the protocols, a teaching nurse noted theimpact of the theory of human caring and similar theories onnursing practice:

The theory of human caring is one of several nursingtheoretical perspectives that evolved during the mid-70s/early 80s, all of which I would say have certainly had aninfluence on nursing practice. In particular, they haveprovided nurses with a knowledge base that helps themto know how to be present with persons in ways that

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contribute to health, healing, and quality of life … Havingthis knowledge base gave nurses the confidence to movebeyond the doing of medically-related tasks, to focus onthe nurse–patient relationship as the core of nursingpractice. (Nurse, participant #25; emphases mine)

Practice following the theory of human caring reorganizescaring work as it validates and professionalizes the emotionallabour done by nurses. It shifts a focus of care from abiomedical to a biopsychosocial model. One of the “carativefactors” outlined byWatson (2006) includes the “[c]ultivationof sensitivity to one's self and to others” that I argue broughtkey actors in the change to a new understanding of theexperience of perinatal death. Within this theory and inpractice, caring is seen in interaction, in dialogue, where newmeaning was made.

Interaction with and care of others

Conducting the interviews for this study, it soon becameapparent to me that the key actors “cared about” the painand suffering of the women. They repositioned themselvesand remade their roles as caregivers to allow for interven-tions to help mitigate the trauma of perinatal loss. Theywere compassionate in their care as they showed both adeep awareness of suffering and a desire to relieve it; or, asone of the participants said, recalling its Latin roots,“compassion means to walk with a person in their suffering”(physician, participant #8). Thus, in addressing women'sgrief, key actors both recognized and responded to women'sneeds through helpful high-touch interventions whichrequired their emotional labour. That this emotional labourwas helpful to a grieving mother was articulated well by aparticipant who was a nurse as well as a bereaved mother.About the relatively recent event of her baby's beingstillborn, she said that “all of the nurses cried; they wereso human. Years ago we were taught you never to do that,you step aside. It comforted me to know they werecompassionate” (nurse, participant #34).

It was through interaction in an environment of high-touch caring relationships that the perinatal bereavementprotocols were born. It was in interaction that the key actorscame to recognize a need for change. The protocols werebased in the key actors' recognition of a need to shift thefeeling rules, or the “[g]uidelines for interaction that consist ofunderstandings about what kinds of emotions are acceptableor desirable, who is entitled to feel and express them, andwhat forms of expression and display are permissible”(Sandstrom et al., 2003, pp. 146–147). Prior to the formationof the bereavement protocols, the feeling rules were based ondismissal: the event was best handled with minimal expres-sion. This was seen in the administration of sedatives, andwhere womenwere “vaguely and evasively told not to worry”(Sudnow, 1967, pp. 112–113).

Changing feeling rules and high-touch

Through the bereavement protocols, then, key actorschanged the feeling rules as a technology of care emerged.With the protocols, not only were the women allowed andencouraged to express their grief and their joy, but caregivers

were also allowed and encouraged to showactive compassion.While caring roles were embraced by key actors in the shift toperinatal bereavement protocols, they were also remade toincrease interaction and compassionate intervention.

Through their emotional attunement (Hochschild, 2003),allowed by their repositioning, some caregivers came torecognize that mothers not only want to see their babies, butwant to see them looking normal and beautiful, regardless ofwhether they are full-term, malformed, or very premature.Nurses and chaplains try to make the “babies look ‘prettier’ asaway of honouring themother's experience and the life of thebaby” (social worker, participant #28). “Nurses do their owncreative things. Some of them even go out and buy their ownthings if they can't find what they want here to enhance thebaby's appearance, to soften it” (nurse, participant #27).Enhancing a baby's appearance is a way of “normalizing thefact that you didn't have a death, you had a baby” (nurse,participant #32). In this, caregivers were engaged in a high-touch technology of care.

Similarly, a chaplain tells of her attempt to show parents ababy rather than a death:

When I was at … [a hospital] in London [Ontario] as astudent, I couldn't imagine holding a baby that was cold;it was always so hard to do. They had a plastic wovenbasket [for the dead baby] that was so hard. Even thoughthey had a pillow inside I would still try and wrap it up tobe warm, and that helps the family.

The baby was covered and shrouded and placed in binand taken to the morgue. It was so impersonal I wouldwalk with the porter and the security guard to themorgue and I would place the baby in the morgue, and ifthe family wanted to see the baby again, I would go downand get the baby and get warm blankets and baby powderand Vaseline for the lips, and bring the baby up to theparents. (Chaplain, participant #11)

Some compassionate care, described below, came aboutthrough a recognition of grief by coming closer to thewomen'sexperiences of grief, by listening to their stories, and by“transcending the barriers that technology puts up againstreciprocity and human contact” (Franklin, 1999, p. 122).

Stories of women's experiences are found in the literature.There is a qualitative literature that changes thinking andperspective and approach of individual caregivers. We tryto read everything we can get our hands on. Whenwe useour human self in a relationship to be able to sit and listenand ask questions; you don't need a meta-analysis forthat. (Nurse, participant #15)

To use one's self as an intervention and “in a relationship tobe able to sit and listen and ask questions” is descriptive ofcompassionate high-touch care. Learning about the experienceof grief from grieving women was key to the formation of thebereavement protocols, because “pregnancy is a humanexperience rather than a medical experience” (nurse, partici-pant #12). This human experience, whether before theprotocols or since, was cocreated through interaction, whetherthat interaction was based on dismissal or intervention. As I

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found in my research, with the development of the protocols itwas, more often than not, the nurses or chaplains as key actorswhose relationshipwith thewoman resulted in the implemen-tation of an intervention that would comfort her in her grief.Compassion for women in grief was seen as caregiverspositioned themselves between high technology and thegrieving women, as they listened to their stories.

Listening canbeunderstoodbywhatHochschild (2003, p. 68)calls an “emotional attunement to the patient's needs”. Or, as onekey actor said, “Our health care providers need to be goodlisteners” (physician, participant #4). The importance of listeningas a way of learning about grief was reflected in the followingexamples from research participants:

I'm good at listening and I let them do most of the talking.(Nurse, participant #14)

I attended a family-centred conference on bereavement inDenver. The conference was all about losses and not beinglistened to, about being empowered and how thatimpacts on you years later. (Nurse, participant #9)

Sometimes one can only be a presence and listen to needsthat get expressed or that for us as caregivers is intuitive…This is what the family is saying they need. (Chaplain,participant #20)

And, very simply: “Patients teach me” (chaplain, partici-pant #10). But for this teaching and learning to happen, onemust be present and one must listen, over and through thesounds of high technology.

High-touch care involves being present for parents, andsometimes it means encouraging talk and physical contactwith the deceased baby. A chaplain describes how she beginsthe conversation.

I start by getting them to talk about the baby, the face, thehands. It fascinates me that it doesn't matter at what agethe baby is—20 or 22 weeks—you ask them a bit about itand they will say, oh he's got Dad's nose. … They see afamily resemblance. It's a matter of getting them to talkabout the baby and get them to hold the hands, feet,count the toes. (Chaplain, participant #11)

At other times, high-touch care means caregivers doingwhat the parents might not be able or ready to do themselvesin symbolically or ritually marking the end of the life. Anotherchaplain describes one such situation:

If families request a blessing or prayer but aren't comfor-table being there I sometimes do it by myself; but the staffmight be there and the staff acknowledges the baby's lifeand their own feelings. This also values their caring andability to be present in away that familiesmight not be ableto at the time. (Chaplain, participant #26)

High-touch care does not necessarily mean that caregiversunderstand perinatal loss the same way the grieving womendo, but that they “honor the meaning of the baby to theparents even if it is different” from theirs (Jonas-Simpson &McMahon, 2005, p. 127). Listening to women and their stories

is key to understanding what the experience of perinataldeath means to them. Jonas-Simpson and McMahon note thisimportance when they write about “cocreating humanexperience” in the death of a baby prior to birth. While astudent nurse, one of these authors was trying to chartaccurate obstetric biomedical information. The patientstopped her, saying:

I don't care how many pads I have soaked or what myblood pressure is. Do you realize that I have lost my baby?No one acknowledges that this was my baby. Only myhusband understands. Even my mother said, oh, I canhave another one. She doesn't understand and neither doyou. (Jonas-Simpson & McMahon, 2005, p. 127)

The author said she was sorry and sat beside this womanand listened to the meaning the baby had for the mother. Themother was very grateful to have someone listen.

As stated, high-touch compassionate care brought keyactors closer to women in grief where they would listen totheir women's stories. Listening, however, was an insufficientresponse for these innovators, who recognized that women'sgrief needed more helpful interventions through a moresignificant shift in the organization of their work. Toaccomplish these interventions through the bereavementprotocols, key actors in the change pushed institutionalboundaries and challenged the practices of separation andsilence that dismissed women's grief in perinatal loss. Keyactors effected changes to the protocols by challenging andchanging existing practices. The changes they implemented atthe local hospital level eventually became the protocols thatare institutionalized in Health Canada (2000) National guide-lines. Some of the key actors interviewed were also directlyresponsible for collaborating on andwriting the guidelines forHealth Canada. In changing the standard of care for perinatalloss, key actors established a high-touch technology of care asthey repositioned themselves closer to the women and theirexperiences.

Reflections: a high-touch redemption

This article has described how key actors involved in thechanged standard of care for perinatal loss repositionedthemselves in relation to women and high technology,thereby modifying unfavourable consequences of high tech-nology. They recognized the distancing effects medicalizationand high technology had on their caregiver–patient relation-ships and on mother–baby relationships, and therefore onwomen's grief in perinatal loss. Their idea was not to rejecthigh tech, but rather to mediate its problematic effects withhigh-touch care.

Medical science has developed technological tools thathave contributed to medical specialization in childbirth.However, technology is not separate from human activity.The focus of my discussion is on “a spectrum of intercon-nected activity” (Franklin, 1999, p. 30) among humans asskilled and creative interventionists, skilled both in the use ofmedical technologies and in the techniques of care throughhuman interaction. In this article I have illustrated howhospital caregivers repositioned themselves in relation towomen experiencing perinatal loss. Here, technology as

1 The larger research project is a doctoral study, “The emergence ofhospital protocols for perinatal loss, 1950-2000”, undertaken at YorkUniversity, Toronto, Ontario, Canada.

283D. Davidson / Women's Studies International Forum 31 (2008) 278–284

practice, as activity based on what the caregivers came toknow, and what I refer to as a technology of care, has had animpact on women's experience of grief in perinatal loss.

As pregnancy and childbirth were further medicalizedand medical technology became high tech, distancingcaregivers from the birthing women and their dead ordying babies, caregivers engaged in a countermovement ofhigh-touch, repositioning themselves closer to the womenand their experiences of grief in order to meet thewomen's social–emotional needs. This is importantbecause, as Franklin (1999, p.122) notes, “technologymakes it very difficult for people to talk to each other”.Here, however, these caregivers imposed themselvesbetween the medical technologies and their patients.From this proximate position, the caregivers first heardthe women's stories and gave voice to their grief. It mayseem ironic that it is in part because of the distancingeffects of medicalization and high technology on thecaregiver–patient relationship that the new standard ofcare for women experiencing perinatal death was born.However, when we think of “science and technology as oneenterprise with a spectrum of interconnected activity”,stimulating and utilizing each other (Franklin, 1999, p. 30),using a symbolic interactionist lens where we see meaningmade and remade, it is understandable that each can alteror mediate the other.

The production of bereavement protocols to supportwomen's grief in perinatal loss also joins and complementsfeminist concerns about women and reproduction, andespecially the recognition of women's authoritative knowl-edge (Jordan, 1983). While my intent and method in myempirical research were clearly feminist, the researchwas notadvertised as such. What is especially interesting is that Ifound these caregivers were not themselves driven by overtor expressed feminist motivations; they did not use the word“feminist” in relation to their understanding of the phenom-enon of grief in perinatal loss or to their efforts on behalf ofwomen. However, the outcome of the hospital protocols isexpressly women-centred, as women's experiences of losswere recognized and responded to with compassion, andwomenwere provided with the care and choices they had nothad prior to the emergence of the protocols. A fairertreatment of women and greater acknowledgment of afemale type of labour, emotion work, were outcomes.

Looking through the lens of symbolic interactionism,where key actors define and respond to situations based onmeaning arrived at through interaction, I have discussed acase study of local innovation. Most significant is the under-standing of technology as a social activity that can bemodified in response to social–emotional need. I have arguedthat, when the use of technology leads to unfavourableconsequences, humans can, in their innovation and compas-sion for others, reposition themselves in relation to technol-ogy and even reshape technology, such as through atechnology of care, thereby modifying those unfavourableconsequences.

Understanding technology as practice, as human activitybased onwhat people know, liberates it from a path to humanisolation and from our “intoxification” to that technology“squeezing out our human spirit” (Naisbitt et al., 1999, p. 1).When people know differently and when they take innovative

actions, technology can be understood, not necessarily asmanipulative and controlling, but as subject to human actionand interaction. When innovative social actors reorganizetheir work so that technology revolves around people ratherthan people revolving around and restricted by high technol-ogy, we can see technology in its humanpotential. To this end,I have shown high-touch compassionate care as a technologyof care practised on grieving women through hospitalbereavement protocols for perinatal loss as exemplary ofwhat Franklin (1999) refers to as the redemptive possibilitiesof technology.

Acknowledgements

Thanks to Gayle Letherby, Janice Newton, Maggie Kirkmanand Jane Fisher for their skilled and insightful comments, andto Jonathan Whatley for his proofreading and copy-editingsupport. I appreciate the support of the Social Science andHumanities Research Council of Canada towards my doctoraldissertation.

Endnote

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