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"I'M NOT ONE THAT LIKES TO BE TOLD WHAT TO DO"

Permanent Link: http://ncf.sobek.ufl.edu/NCFE004720/00001

Material Information

Title: "I'M NOT ONE THAT LIKES TO BE TOLD WHAT TO DO" A COMPARATIVE STUDY OF CONTROL AND EMPOWERMENT BETWEEN HOSPITAL AND OUT-OF-HOSPITAL BIRTHS
Physical Description: Book
Language: English
Creator: Brenzel, Lauren
Publisher: New College of Florida
Place of Publication: Sarasota, Fla.
Creation Date: 2013
Publication Date: 2013

Subjects

Subjects / Keywords: Birth
Medicalization
Control
Empowerment
Gender
Pregnancy
Hospital
Out-of-Hospital
Genre: bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: According to the 2011 National Vital Statistic Report 98.9% of births take place in hospitals. However, the number of out-of-hospital births has grown in past decade. While perspectives are debated among birthing professionals, theorists, and activists on which setting is the "best" to give birth, there is not a good understanding of women's experiences while giving birth, due to lack of research. This study examines the experiences of individuals who have recently given birth, with a focus on their care provider and birth setting, and assess personal understandings of empowerment and control. Sixteen semi-structured interviews were conducted with individuals who had recently given birth, including eight women who gave birth within the hospital and eight women who gave birth outside of the hospital. This study found that participants who birthed within the hospital did so because of access to medical intervention, and faced greater challenges to control. Out-of-hospital participants an made an active choice to reject intervention, gave more detailed descriptions of their experiences of control and empowerment, and reported closer relationships with their care providers, but were also at risk for greater scrutiny in their birth choices, particularly from loved-ones, due to their choice to birth outside the norm.
Statement of Responsibility: by Lauren Brenzel
Thesis: Thesis (B.A.) -- New College of Florida, 2013
Electronic Access: RESTRICTED TO NCF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE
Bibliography: Includes bibliographical references.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The New College of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Local: Faculty Sponsor: Fairchild, Emily

Record Information

Source Institution: New College of Florida
Holding Location: New College of Florida
Rights Management: Applicable rights reserved.
Classification: local - S.T. 2013 B83
System ID: NCFE004720:00001

Permanent Link: http://ncf.sobek.ufl.edu/NCFE004720/00001

Material Information

Title: "I'M NOT ONE THAT LIKES TO BE TOLD WHAT TO DO" A COMPARATIVE STUDY OF CONTROL AND EMPOWERMENT BETWEEN HOSPITAL AND OUT-OF-HOSPITAL BIRTHS
Physical Description: Book
Language: English
Creator: Brenzel, Lauren
Publisher: New College of Florida
Place of Publication: Sarasota, Fla.
Creation Date: 2013
Publication Date: 2013

Subjects

Subjects / Keywords: Birth
Medicalization
Control
Empowerment
Gender
Pregnancy
Hospital
Out-of-Hospital
Genre: bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: According to the 2011 National Vital Statistic Report 98.9% of births take place in hospitals. However, the number of out-of-hospital births has grown in past decade. While perspectives are debated among birthing professionals, theorists, and activists on which setting is the "best" to give birth, there is not a good understanding of women's experiences while giving birth, due to lack of research. This study examines the experiences of individuals who have recently given birth, with a focus on their care provider and birth setting, and assess personal understandings of empowerment and control. Sixteen semi-structured interviews were conducted with individuals who had recently given birth, including eight women who gave birth within the hospital and eight women who gave birth outside of the hospital. This study found that participants who birthed within the hospital did so because of access to medical intervention, and faced greater challenges to control. Out-of-hospital participants an made an active choice to reject intervention, gave more detailed descriptions of their experiences of control and empowerment, and reported closer relationships with their care providers, but were also at risk for greater scrutiny in their birth choices, particularly from loved-ones, due to their choice to birth outside the norm.
Statement of Responsibility: by Lauren Brenzel
Thesis: Thesis (B.A.) -- New College of Florida, 2013
Electronic Access: RESTRICTED TO NCF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE
Bibliography: Includes bibliographical references.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The New College of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Local: Faculty Sponsor: Fairchild, Emily

Record Information

Source Institution: New College of Florida
Holding Location: New College of Florida
Rights Management: Applicable rights reserved.
Classification: local - S.T. 2013 B83
System ID: NCFE004720:00001


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IM NOT ONE T HAT LIKES TO BE TOLD WHAT TO DO: A COMPARATIVE STUDY OF CONTROL AND EMPOWERMENT BETWEEN HOSPITAL AND OUT OF HOSPITAL BIRTHS BY LAUREN BRENZEL A Thesis Submitted to the Division of Social Sciences New College of Florida in partial fulfillment of the requirements for the degree Bachelor of Arts Under the sponsorship of Emily Fairchild Sarasota, Florida May 2013

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ACK N OW LED G E M E N TS I w o ul d lik e to t h a n k P r o f e ss o r E m ily F a i r c hi l d, w h o n ot o n l y s po n s o r e d t hi s t h e s i s b ut pr o vi de d m e w i t h i m m e n s e pr act i c a l a n d e m o t i o n a l s uppo r t i n t h e t h e s i s pr o j ect I a l s o wa n t to t h a n k P r o f e s s o r F a i r c hild f o r c l a r i f y i ng m y in t e r e s t i n s o c i o l ogy a n d f o r e n c o ur a g in g a n d c h a l l e n g i ng m e o v e r t h e f o ur y ear pe r i o d w e h a v e w o r ke d t o ge t h e r I a l s o wa n t to t h a nk P r o f e ss o r S a r a h He r n a n de z a n d P r o f e s s o r B r e n da n G o f f f o r b e in g o n m y t h e s i s c o m m i ttee. T o t h e w o n de r f u l w o m e n o f M a t e r n a lly Y o ur s ( L a ur a G ilke y C a r m e l a P e d i c i n i R y a n Ha r t f o r dS t a nl e y a n d C h e r y l K i ndr ed ) y o u h a v e m a de m e f e e l u nb e l i e v a bly s uppo r t e d a n d e n c o ur a ge d. W o r kin g w i t h y o u h a s b e e n a n a m az in g e x pe r i e n c e t h a t I c h e r i s h s o m uc h C a r m e l a, s pe c i a l t h a n k s to y o u f o r a l l y o ur w o r k w i t h m e o n t hi s s pec i f i c pr o j e c t I l o v e y o u a ll! P a t W o l f s o n y o u h a v e t r u l y h e l pe d m e b e a t a pl a c e w h e r e I a m c o nf i de n t i n my po s i t i o n i n lif e ( a h a r d t hin g f o r a r ecen t gr ad ) Y o ur m e n t o r s hi p h a s b e e n pr i c e l e ss a n d I h a ve s o t h o r o ughl y e nj o y e d a ll t h e t ime I h a ve s p e n t w o r kin g w i t h y o u. T h a n k y o u f o r e v e r y t hi ng. A r t h ur M uga n I l o ve y o u s o deep l y Y o u a r e m y f o un da t i o n a n d m y b e s t f r i e n d. Y o u p r o vi de d m e w i t h m uc h o f t h e e n c o ur a ge m e n t I n e e de d to w o r k o n t hi s p r o j e c t a n d y o u h a v e h e l pe d m e t h r o ugh s o m uc h o f my w o r k. T h a n k y o u f o r lis t e nin g t o m e r a n t r a m bl e a n d pr act i c e p r e s e n t a t i o ns Y o u a r e t h e b e s t M i a New e l l a n d M i c h e l l e P a tt e s o n y o u a r e t h e b e s t f r i e n ds a ny o n e c ou l d a s k f o r Y o u b r i ng s o m uc h j o y in t o m y l i f e a n d a r e t h e r e f o r m e f o r a ny t hin g. T h a n k y o u. R a c h a e l Ha e n s l y t h a n k y o u f o r y o u f o r T h ur s da y w o r k s e s s i o n s Y o u h a v e b r o ugh t s o m uc h f u n t o t h e t h e s i s p r o cess. L y nn G u s m a n y o u a r e t h e b e s t C o P r e s i de n t a ny o n e c ou l d a s k f o r F r a n ces c a L e y va y o u h a v e t r u l y b e e n o n e o f m y r o l e m o de l s f o r t h e s e s i ng. Y o u a r e a m a z i ng, a n d o n e o f t h e s m a r t e s t f u nni e s t t o ug h e s t pe o pl e I kn o w I l o v e y o u! P a t r i c k R us s e ll, J a ke P a i v a E mma W o lin P e n e l o pe L i nd s e y P a t r i ck M c B r a t n e y a n d T a y l o r P a r ke r y o u a r e each a m a z i ng f r i e n ds w h o h a ve h e l pe d m e w h e n I t r ul y n eed e d i t Y o u a r e w o n de r f u l To my mom and dad, thank you for all your support. I love you so much! i

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T o a l l o f my pa r t i c i pa n t s i t m e a n s s o m uc h to m e t h a t y o u w o ul d t a ke t h e t ime to w e l c o m e a s t r a n ge r in t o y o ur h o m e s o t h a t t h e y c o u l d do t h e i r r e s ear c h e s pe c i a lly w i t h a n ew b a by I h a d a w o n de r f u l t ime c o n duc t in g t h i s r e s e a r c h due i n l a r ge pa r t to h o w awes o m e eac h o f y o u we r e T h a n k y o u a ga in s o m u c h. ii

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T A B L E OF C O N TEN TS A cknowledgements i Table of Contents iii Abstract ... i v I n t r o duc t i o n 1 L i t e r a t ur e R e vi e w 7 M e t h o d o l o gy ... 28 A n a l y s i s a n d D i s c u ssi o n ............... 33 C o n c l u s i o n .. ... 66 A ppe n d i x ..... 71 B i bl i o gr a p hy 73 iii

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IM NOT ONE THAT LIKES TO BE TOLD WHAT TO DO: A COMPARATIVE STUDY OF CONTROL AND EMPOWERMENT BETWEEN HOSPITAL AND OUT OF HOSPITAL BIRTHS Lauren Brenzel New College of Florida A B S T RACT A cco r d in g to t h e 2011 N a t i o n a l V i t a l S t a t i s t i c R e por t 98. 9 % o f bi r t hs t a ke p l ace i n h o s p i t a l s H o we v e r t h e n u m be r o f o u t o f h o s p i t a l bi r t h s h a s g r o w n i n pa s t decade W hi l e p e r s pect i v e s a r e de b a t e d a m o n g bi r t hi ng pr o f e ssi o n a l s t h e o r i s ts a n d act i vi s t s o n w hi c h s e tti n g is t h e b e s t to giv e bi r t h there is not a go o d un de r s t a n d i ng o f w o m e n s e x pe r i e n c e s w hil e g i v i ng bi r t h due to lack of research T hi s s t ud y e x a m i ne s t h e e x pe r i e n ce s o f i n d i v i dua l s w h o h a v e r ece n t l y g i ve n bi r t h w i t h a f o c us o n t h e i r car e pr o v i d e r a n d birth s e ttin g, a n d a s s e s s pe r s o n a l u n d e r s t a n d i n g s o f e m po we r m e n t a nd c o n t r o l S ix t een s e m i s t r uc t u r e d in t e r vi ew s we r e c o n duc t e d w i t h in d i v i dua l s w h o h a d recently given birth, in c l ud i ng e i g h t w o m e n w h o ga v e bi r t h w i t hi n t h e h o s p i t a l a n d e i g h t w o m e n w h o ga v e bi r t h o u t s i de o f t h e h o s p i t a l T hi s s t ud y f o u n d t h a t pa r t i c i p a n t s w h o bi r t h e d w i t hi n t h e h o s p i t a l d i d s o b e c a us e o f acc e s s to m e d i ca l in t e r v e n t i o n and faced gr eater challenges to control. Out of hospital participants an m a de a n act iv e c h o i c e to r e j ect in t e r v e n t i o n ga v e m o r e de t a il e d de s c r i pt i o n s o f t h e i r e x pe r i e n c e s o f c o n t r o l a n d e m po we r m e n t and r e p o r t e d c l o s e r r e l a t i o n s hi ps w i t h t h e i r car e pr o v i de r s iv

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but we r e a l s o a t r i s k f o r gr e a t e r s c r ut i ny i n t h e i r bi r t h c h o i ce s pa r t i c u l a r ly f r o m l o v ed o n e s due to t h e i r c h o i c e to bi r t h o u t s i de t h e n o r m Thesis Sponsor Emily Fairchild Division of Social Sciences v

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1 I. INTRODUCTION T h e c h o i c e o f w h e r e to g iv e b i r t h t o d a y i n t h e U n i t e d S t a t e s f o r m a n y m a y s e e m l i ke a p r e t t y s t r a i g h t f o r wa r d o n e : b a b i e s a r e b o r n a t o n e s l o c a l h o s p i t a l a n d o n e o f t h e l a r g e s t d e c i s i o n s i s w h o y o ur O B / GY N i s g o in g to b e T hi s a t t i t ude i s ce r t a i nly r e f l ec t e d i n a Na t i o n a l V i t a l S t a t i s t i c s R e p o r t f r o m t h e Na t i o n a l C e n t e r f o r He a l t h S t a t i s t i c s ( N C H S) w h i c h n o t e s t h a t 98 9 % o f a l l b a b i e s we r e b o r n i n h o s p i t a l s i n 2009 ( N C H S, 2011 ) H o we v e r t hi s n ea r l y t o t a l r e li a n c e o n t h e h o s p i t a l b i r t h i ng m o d e l i s n o t t h e only w a y a n i n d i v i du a l c a n c h oo s e to g iv e b i r t h I n f ac t t h e r e h a s b e e n a n o v e r 30% i n c r ea s e i n h o m e b i r t h s b e t wee n 2004 a n d 2009 f o r n o n H i s p a n i c w h i t e w o m e n A cc o r d in g to a n o t h e r s t u d y f r o m t h e N C H S, a m o n g o ut o f h o s p i t a l b i r t h s 67 2 pe r ce n t we r e i n a r e s i d e n c e ( h o m e ) a nd 27 6 we r e i n a f r ee s t a n d i ng b i r t h i ng c e n t er ( M acD o r m a n M a r i a n F T J M a t h ew s & E ug e n e De c l e r c q 2012 ) S t ud i e s h a v e s h o w n t h a t o u t o f h o s p i t a l b i r t h s w i t h m i d w i f e a s s i s t a n c e a r e a v i a b l e o p t i o n f o r in d i v i du a l s w i t h l o w r i s k p r e g n a n c i e s ( A m e r i c a n P u bl i c He a l t h A ss o c i a t i o n 2002; A n d e r s o n R E M u r phy P A 1995; Z w e i g & O li v e r 2009) a n d t h a t t h e r e m a y b e s o m e p e r s o n a l b e n e f i t s g a in e d by h a v in g a n o u t o f h o s p i t a l b i r t h ( C h r i s t i a e n s a n d B r a ke 2011; P a r r y 2006; P a r r y 2008 ). T h e r e a r e m a ny p r e g n a n c i e s i n w h i c h t h e p r e s e n c e o f t h e h o s p i t a l i s a n ec e s s i t y A l a r ge n u m b e r o f p e o p l e do n ot h a v e t h e p r i vi l e ge o f h a vi n g un c o m p li c a t e d o r l o we r r i s k p r e g n a n c i e s F o r t h e s e i n d i v i du a l s t h e h o s p i t a l m a y b e t h e b e s t m o d e l o f ca r e p r o v i d i n g a t t im e s l i f e s a v i ng in t e r v e n t i o n f o r b o t h t h e in d i v i d u a l b i r t h in g a n d t h e i r i n f a n t F u r t h e r m o r e s o m e i n d i v i d u a l s m a y j u s t h a v e a p e r s o n a l p r e f e r e n c e f o r t h e h o s p i t a l s e t t i ng. I n t e r v e n t i o ns s u c h a s p a i n m e d i ca t i o n,

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2 c o n s i s t e n t m o n i t o r in g, a n d e v e n C s ec t i o n m a y b e d e s i r e d by t h e i n d i v i du a l H o we v e r t h i s l og i c d o e s n ot w o r k b o t h wa y s : t h e h o s p i t a l m o d e l o f b i r t h in g i s t h e o n e w h i c h i s v a l u e d m o s t w i t h i n o ur s o c i e t y I n d i v i du a l s w h o c h oo s e to b i r t h o u t s i d e o f t h e h o m e m a y f a c e a g r ea t d e a l o f c r i t i c i s m f o r t h e i r c h o i ce s ( P a r r y 2008 ) a n d t h e y d o n ot h a v e t h e s upp o r t o f b i r t h i ng i n a w a y t h a t t h e m a j o r i t y o f s o c i e t y f i nds acce p t a b l e L ac k o f g e o g r a ph i c acc e s s t o o u t o f h o s p i t a l ca r e o r l ac k o f k n ow l e dge a b o ut o u t o f h o s p i t a l b i r t h m a y a l s o p r e v e n t in d i v i du a l s f r o m s e e k in g o u t o f h o s p i t a l ca r e T h e s e f ac t o r s c o m b i ne t o m a k e f u r t h e r e x a mi n a t i o ns in t o t h e r i s k s a n d b e n e f i t s o f ea c h ca r e m o d e l p a r t i c u l a r ly i m p o r t a n t e s p ec i a l ly a s w e w o r k to c r ea t e a s y s t e m w h e r e i n d i v i du a l s c a n acc e s s w h a t e v e r ca r e i s b e s t s u i t e d to t h e m a n d t h e i r n eed s P r ac t i ce s w h i c h s u s p e n d acce s s to mi d w i f e ca r e a r e o f t e n ce n t e r e d o n o ur c u l t u r a l a t t i t ud e s w h i c h c u rr e n t l y do n ot f u l ly s upp o r t o u t o f h o s p i t a l b i r t h s T h e s e d i s c u s s i o ns a r e i m p o r t a n t w h e n c o n s i d e r i ng a s p ec t s o f t h e h o s p i t a l b i r t h i ng e x p e r i e n c e w h i c h c ou l d be n e g a t i ve f o r s o m e i n d i v i d u a l s O f p a r t i c u l a r r e l e v a n c e i s t h e d i s c u ss i o n s u rr o u n d in g t h e m e d i c a l i za t i o n o f b i r t h a n d p r e gn a n c y C o n r a d ( 2008) d e s c r ib e s m e d i c a l i za t i o n a s a p r o ce s s by w h i c h n o n m e d i ca l p r o b l e m s b ec o m e d e f i n e d a n d t r e a t e d a s m e d i ca l p r o b l e m s ( 1992: 211) M e d i c a l i za t i o n m a y ca u s e p e op l e to p r o b l e m a t i z e e x p e r i e n c e s w i t h t h e ir b o dy w h i c h a r e n o t n ece s s a r i ly d a n g e r o us or p a t h o l og i c a l M a ny t h e o r i s t s h a ve s ugg e s t e d a c u l t u r e o f f ea r s u rr o u n ds p r e g n a n c y a n d b i r t h i ng i n o ur s o c i e t y ( C a hi l l 200 1 ; C h r i s t i a e n s a n d B r ac k e 2011; M a r s h a ll & W oo ll e t t 2000, R e i g e r K e rr e e n & R h e a D e m p s e y 2006 ) a n d t h e s e f ea r s r e l a t e d to p r e g n a n c i e s m a y n e g a t iv e ly i m p act i n d i v i du a l s a s w e l l a s o ur s o c i e t a l p e r ce p t i o ns o f f e m a l e a s s i g n e d p h y s i o l og i c a l e v e n t s a s a w h o l e T h i s c o n ce p t i o n m a y p r e v e n t

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3 in d i v i du a l s f r o m h a v in g a n in t e r e s t i n b i r t h i ng o u t o f h o s p i t a l b eca u s e i t m a k e s t h e m b e li e ve d o in g s o w o u l d be un s a f e T h e p o s s i b l e f ea r a ss o c i a t ed w i t h m e d i ca li z e d u n d e r s t a n d i ngs o f p r e g n a n c y s h o w s o n e w a y w e h a ve b ee n c u l t u r a l ly c o n d i t i o n e d to p r e f e r h o s p i t a l b i r t h T h e r e s t r i c t i o n o f in d i v i du a l s f r o m b i r t h i ng o u t s i de o f t h e h o s p i t a l d o e s n o t o nl y t a ke p l ac e t h r o ugh s o c i a l c o n d i t i o n i n g ; t h e r e a r e o f t e n p o li c i e s a n d l e g i s l a t i o n w h i c h a ff ec t t h e w a y t h a t p e o p l e d o b i r t h A cc o r d in g to t h e M i d w i v e s A l l i a n c e o f N o r t h A m e r i ca a s o f 2011 t h e r e a r e t e n s t a t e s i n w h i c h t h e p r ac t i c e o f mi d w i f e r y w i t h o ut a d o c t o r s d i r ec t s up e r v i s i o n i s e n t i r e ly il l e g a l a n d t w o s t a t e s i n w h i c h i t i s n o t t ec h n i ca lly i l l e g a l b ut li c e n s u r e f o r p r a c t i c in g m i d w i f e r y i s u n a v a i l a b l e W i t h i n t h e s t a t e s i n w h i c h m i d w i f e r y i s il l e g a l mi d w i v e s c a n b e a rr e s t e d f o r p r ac t i c i ng m e d i c i ne w i t h o ut a li c e n s e d e s p i t e an y p r e v i o us e x p e r i e n c e w i t h mi d w i f e r y o r l i c e n s in g a n d ce r t i f i ca t i o n i n o t h e r s t a t e s T h i s pu t s mi d w i v e s a t r i s k f o r a rr e s t e v e n i f t h e r e h a v e b e e n n o in c i d e n t s du r in g a ny o f t h e b i r t hs w h i c h t h e y h a v e a ss i s t ed T h e s e s t a t e s l im i t s o n m i d w i f e r y b a r a ny p o t e n t i a l b e n e f i t s w h i c h c ou l d be g a r n e r e d f r o m o ut o f h o s p i t a l ca r e a n d f o r c e t h e j o u r n e y o f p r e g n a n t in d i v i du a l s w h o wa nt l e g a l a s s i s t e d b i r t h s in t o t h e h o s p i t a l e nv i r o n m e n t w i t h n o e x a mi n a t i o n o f t h e ca r e m e t h o d w h i c h m a y b e b e s t s u i t e d f o r o r p r e f e rr ed by t h e m W hi l e t h e h o s p i t a l s e t t in g i s t h e m o s t c o m m o n p l a c e f o r g i v in g b i r t h c r i t i qu e s o f t h is m o d e l do e x i s t T h e r e a r e a v a r i e t y o f a s p ec t s o f t h e h o s p i t a l b i r t h s e tt in g w h i c h t h e s e c r i t i qu es f o c us o n in c l u d i n g : in c r e a s e d m e d i ca li z a t i o n ( C h r i s t i a e ns a n d B r a ke 2011; C h e r v e n a k & M c C u l l o u g h 2005; Z w e i g & O li v e r 2009 ) l ac k o f p a t i e n t c o n t r o l ( M o o r e 201 1 ) g a ps i n k n ow l e dge a b o ut t h e p r o ce ss e s o f p r e g n a n c y a n d l a b o r by

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4 p a t i e n t s ( R o s e n t h a l 2006 ) t he b o l s t e r in g o f s o c i e t a l f ea r s u rr o u n d in g p r e g n a n c y ( M a r s h a ll & W oo ll e t t 2000; R e i g e r K e rr e e n & R h e a D e m p s e y 2006 ) a n d a i d i ng i n a g e n e r a l f e e l i ng o f d i s c o n n ec t f r o m t h e p r o ce s s o f l a b o r ( C a r t e r 2010 ) T h e s e c r i t i qu e s o f t h e h o s p i t a l m od e l a n d l ac k o f s upp o r t f o r a n d a t t e n t i o n p a i d to t h e o u t o f h o s p i t a l mi d w i f e a ss i s t e d m o d e l compel examination into t h e c u rr e n t s i t u a t i o n i s w i t h h o s p i t a l b i r t h a n d i t s a l t e r n a t iv e s I t h a s b ee n a r gu e d t h a t o n e w a y i n w h i c h t he o u t o f h o s p i t a l mi d w i f e a s s i s t e d b i r t h i ng m o d e l i s o f t e n p a r t i c u l a r ly s t r o n g i s i n p e r s o n a l s upp o r t a n d a l l ow i ng g r ea t e r a u t o n o m y i n t h e b i r t h s e tt in g ( C a r t e r 2010; S h a w a n d K i t z i ng e r 2005 ) T h i s t h e s i s w i ll e x p o u n d up o n t h i s w o r k, a n d i s c o n c e n t r a t e d o n t h i s r e s ea r c h q u e s t i o n : H o w d o es birth s e t t in g a n d ca r e p r o v i d e r du r in g l a b o r a ff ec t a n in d i v i du a l s p e r ce p t i o n o f e m p o we r m e n t a n d c o n t r o l i n t h e b i r t h in g e x p e r i e n c e ? T h e r e i s n o t a g r e a t d e a l o f w o r k c o m p a r in g t h e e xp e r i e n c e s o f in d i v i d u a l s w h o o p t e d f o r h o s p i t a l b i r t hs a n d t h o s e w h o p a r t i c i p a t e d i n n o n n o r m a t i ve b i r t h in g p r ac t i c e s s u c h a s o ut o f h o s p i t a l m i d w i f e a s s i s t e d b i r t h s S t u d i e s li ke t h e s e a r e n e ce s s a r y i n o r d e r to u n d e r s t a n d t h e ac t u a l e x p e r i e n c e o f in d i v i du a l s a s w e l l a s h o w t h e y a r e a b l e ( or u n a b l e ) to e x e r t a ut o n o m y a n d e x p e r i e n c e e m p o we r m e n t i n t h e i r bi r t hin g. T h i s s t u d y u t i l i z e s qu a l i t a t i v e m e t h o ds i n a n a t t e m pt to c o m p a r e t h e e x p e r i e n c e s o f c i s w o m e n ( in d i v i du a l s w h o a r e b o t h f e m a l e a s s i g n e d a t b i r t h a n d w o m a n i d e n t i f i e d) w h o h a ve r ece n t l y g i v e n b i r t h i n d i ff e r e n t s e t t in gs a nd w i t h d i f f e r e n t t y p e s o f b i r t h in g ca r e p r o v i d e r s T h e f o c us o f t h i s s t udy the experiences of birthing in the n o r m a t iv e m o d e l ( h o s p i t a l b i r t h ) a s compared to t h o s e w ho p a r t i c i p a t e i n n o n n o r m a t iv e m o d e l s p a r t i c u l a r l y h o m e b i r t h s a n d mi d w i f e r un b i r t h s e tt in g s or b i r t h in g h o m e b i r t h s I a m c h i e f ly in t e r e s t e d i n e x a m i n i ng experiences i n o n e s a bil i t y t o a ss e r t c o n t r o l a s w e l l a s

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5 h o w m u c h c o n t r o l wa s r e g u l a t e d o n t h e p a r t i c i p a n t s by o t h e r s a s s i s t in g i n t h e i r b i r t h h o w m u c h f r ee d o m t h e y f e l t t h e y h a d i n t h e b i r t h e x p e r i e n ce a n d w h o i s g i v e n a u t h o r i t y i n t h e b i r t h s i t u a t i o n I a m h op in g t h a t t h e s e e x a m i n a t i o n s w ill p r o v i de f u r t h e r e v i d e n c e a s to w h e t h e r o r n ot t h e d i f f e r e n c e s b e t we e n h o s p i t a l a nd o u t o f h o s p i t a l ca r e t h a t h a ve b ee n p r o p o s ed by s o m e n a t u r a l b i r t h i ng ac t i v i s t s t r u l y e x i s t s a s w e l l as h o w e m p o we r m e n t a n d p e r s o n a l c o n t r o l f u n c t i o n w i t h i n ea c h s e tt in g. T h e d a t a c o ll ec t e d i n t h i s s t udy r e s u l t f r o m qu a l i t a t i ve s e m i s t r u c t u r e d in t e r v i ew s T h e in t e r v i ew s we r e c o n du c t e d w i t h i n d i v i d u a l s w h o l i v e d w i t h i n t h e S a r a s o t a F l o r i da a r ea o r r ec e iv e d t r ea t m e n t f r o m a n a r e a b a s e d ca r e p r o v i d e r T h e a r e a o f S a r a s o t a i s a p a r t i c u l a r ly in t e r e s t in g a r e a to e x a mi ne i n t h i s r e a lm T h e r e a r e t w o b i r t h in g h o m e s a n d s e v e r a l in d e p e n d e nt m i d w i v e s l o ca t e d i n t h e a r ea a s we l l a s a f e w m a j o r a r e a h o s p i t a l s T h e m a j o r a r e a h o s p i t a l m o s t c o m m o nly a t t e n d e d by p a r t i c i p a n t s i n t h i s s t u d y i s n a t i o n a lly r a n k e d f o r i t s m a t e r n i t y ca r e b ut a l s o k n o w n v e r y w e ll f o r i t s h i g h C e s a r e a n s ec t i o n r a t e s ; w i t h a r a t e o f 41 3% i n 2007, n ea r l y d o ub l e t h e n a t i o n a l a v e r a ge f o r t h a t y ea r a n d a l m o s t t h r e e t im e s t h e W o r l d He a l t h O r g a n i za t i o n s m a x im u m C s e c t i o n r ec o mm e n d a t i o n r a t e o f 15% ( G il k e y 200 9 ; C hi l d b i r t h C o n n ec t i o n 201 2 ; C h a il l e t e t a l 2007 ) T h i s p r o v i d e s s o m e e v i d e n c e t h a t t h e u s e o f m e d i c a l in t e r v e n t i o n i s h i g h i n t h e h o s p i t a l s e t t in g. F u r t h e r s upp o r t f o r S a r a s o t a b e in g a p a r t i c u l a r ly in t e r e s t in g s i t e f o r t h i s r e s e a r c h i s t h e li v e ly c o m mun i t y o f b i r t h i ng ac t i v i s t s i n t h e a r ea M a ny o f t h e s e in d i v i du a l s w h o a d v o ca t e f o r o u t o f h o s p i t a l b i r t h i ng, o r c h a n g e s t o t h e h o s p i t a l m o d e l h a v e t h e m s e l v e s g i v e n b i r t h a t h o m e o r i n a b i r t h i ng h o m e ( s o m e o f t h e s e i n d i v i du a l s a r e r e p r e s e n t e d i n m y s a m p l e ) T h e s e p a r e n t s / ac t i v i s t s a r e o f t e n a l s o i n v o lv e d w i t h o t h e r ac t i v i s m r e l a t e d to b i r t h in g

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6 a n d c h il d c a r e s u c h a s t h e a n t i c i r c u m c i s i o n m o v e m e n t t h e a n t i v ac c i ne m o v e m e n t a n d a l t e r n a t i ve e du ca t i o n c h o i c e s s u c h a s h o m e s c h oo li ng o r u n s c h oo li ng. B eca u s e o f t h i s s o r t o f p a r e n t in g s u b c u l t u r e i t i s in t e r e s t in g to n o t e t h a t m a ny i n d i v i du a l s t h o ugh n o t a l l w h o p a r t i c i p a t e i n o u t o f h o s p i t a l b i r t h in g a r e li nk e d in t o t h i s n e t w o r k. T h e n e x t s ec t i o n o f t h i s t h e s i s w ill f o c u s o n a l i t e r a t u r e r e v i e w w h i c h h e l p s e x p o u n d up o n s o m e o f t h e i s s u e s d i s c u ss e d w i t h i n t h i s in t r o du c t i o n T hi s in c l u d e s a m o r e in d e p t h d i s c u ss i o n o f m e d i c a l i za t i o n a n d in d i v i d u a l s e x p e r i e n c e s w i t h i t r e v i e w o f r e l e v a n t l i t e r a t u r e s u r r o u n d in g t he a r ea s o f e m p o we r m e n t a n d c o n t r o l a n d f u r t h e r e x a m i n a t i o n in t o t h e c r i t i qu e s o f b o t h t h e h o s p i t al a n d o ut o f h o s p i t a l b i r t h i ng m o d e l T h e n e x t c h a p t e r g iv e s a m o r e d e t a il e d d e s c r i p t i o n o f my m e t h o d o l og y in c l u d i ng d e m o g r a ph i c i n f o r m a t i o n o n m y p a r t i c i p a n t s a n d f u r t h e r d i s c u s s i o n o f my in t e r v i e w i ng a n d a n a ly s i s p r o ce ss T h e f o l l ow i n g c h a p t e r f o c u s e s o n a n a l y s i s a n d d i s c u ss i o n s u rr o u n d in g t h i s s t u d y w h i c h h i g h li g h t t h e m o s t r e l e v a n t f i n d i n g s w i t h a m a j o r f o c us on p a r t i c i p a n t e x p e r i e n ce s o f c o n t r o l e m p o we r m e n t, a n d s upp o r t i n t h e b i r t h s e t t in g. T he c o n c l u s i o n o f t h i s thesis e x p a n d s up o n t h e p o s s i b l e im p li ca t i o ns o f m y r e s ea r c h a n d a l s o d i s c u ss e s r e l e v a n t f u t u r e r e s ea r c h w h i c h c ou l d b e c o n du c t e d i n t h e s o c i o l og i ca l s t u d y o f b i r t h

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7 II L I T E RA T U R E I n g e n e r a l t h e b i r t h o f a c hi l d i s a t r a n s f o r m a t iv e a n d p iv o t a l m o m e n t i n a p e r s o n s l i f e I t i s a l s o a c u l t u r a l ly a n d s o c i a lly c o n s t r u c t e d e v e n t B i r t h i s a s ub j e c t w h i c h h a s b e e n u n d e r s t u d i e d i n s o c i o l og y b ut i s r i f e w i t h m a t e r i a l f o r s o c i o l og i c a l s t u d y due to i t s im p ac t a n d im p l i ca t i o n s o n t h e in d i v i du a l a n d f a mil i a l l e v e l a s w e ll a s w i t h i n o ur s o c i e t y T h e r e a r e m a ny e x p ec t a t i o ns a b o ut t h e wa y pe op l e w i l l g i ve b i r t h w h e r e t h e y w ill do i t a n d h o w t h e y w i ll ac t acc o r d i n g t o s o c i a l n o r m s ( C a hi l l 2011 ) I n d i v i du a l d e s i r e s w i t h i n t h e b i r t h s e t t in g m a y b e a t c o n f l i c t w i t h s o c i e t a l e x p ec t a t i o n s a b o ut b i r t h in g. T h e r e s ea r c h in t h i s t h e s i s i s f o c u s es o n e x p e r i e n c e s o f c o n t r o l a n d e m p o we r m e n t i n t h e b i r t h s e tt i n g, i n p a r t i c u l a r h o w w o m e n a r e ( o r a r e n o t ) a b l e t o n e g o t i a t e c o n t r o l a n d g a i n e m p o we r m e n t w h il e g i v i n g b i r t h I n acc o r d a n ce t hi s l i t e r a t u r e r e v i ew w i ll d i s cu s s w h a t m e d i c a l i za t i o n i s a n d h o w i t c u r r e n t l y a ff ec t s in d i v i du a l s g i v i ng b i r t h I t w ill t h e n p r o v i de a b r i e f h i s t o r y o f m e d i c a l i za t i o n a n d p r o v i de s o m e a r g u m e n t s f o r t h e w a ys m e d i c a l i za t i o n h a s b e e n a r gu e d to i n f l u e n c e in d i v idu a l a n d c o ll e c t i ve ac t i o n w i t h i n b i r t h I t w i ll t h e n h i g hl i g h t t h e w a y s t h a t m e d i c a l i za t i o n h a s b e e n r e l a t e d to i ss u e s o f c o n t r o l a n d e m p o we r m e n t F in a ll y i t w i ll t r ac k s o m e i ss u e s w i t h i n t h e e x i s t in g l i t e r a t u r e i n o r d e r to s up p o r t t h e r e s ea r c h u n d e r t a k e n w i t h i n t h i s s t ud y M e di c a l i z a t ion A c c e s s to m e d i c a l in t e r v e n t i o n m a y b e o n e o f t h e m a i n r e a s o n s t h a t a n in d i v i du a l s ee k s a h o s p i t a l b i r t h S o m e e x a m p l e s o f g i v i ng b i r t h i n t h e h o s p i t a l f o r t h i s r ea s o n

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8 in c l ude a f ea r o f s o m e t h in g g o in g w r o n or a d e s i r e to r ece iv e p a in m e d i ca t i o n T h i s f o c us o n m e d i ca l in t e r v e n t i o n a s a p a r t o f b i r t h i s r e f l e c t iv e o f t h e w a y s b i r t h h a s b e c o m e in c r e a s i n g l y m e d i c a l i ze d. I n h i s 1992 r e v i e w o f t h e l i t e r a t u r e o n m e d i c a l i z a t i o n C o n r a d ( 1992) s t a t e s t h a t m e d i c a l i za t i o n c o n s i s t s o f d e f i n i ng a p r o b l e m i n m e d i ca l t e r m s u s i ng m e d i ca l l a n gu a g e to d e s c r ib e a p r o b l e m a d o p t in g a m e d i c a l f r a m e w o r k to u n d e r s t a n d a p r ob l e m o r u s in g a m e d i c a l in t e r v e n t i o n to t r e a t i t ( 1992: 21 1 ) M e d i c a l i za t i o n i s t h e r e f o r e a d e f i n i t i o n a l p r o ce ss t h r o ugh wh i c h p r o b l e m s a r e e v a l u a t e d, t r e a t ed a n d o b s e r v e d acc o r d in g t o m e d i c a l l a n gu a ge a n d u n d e r s t a n d i ngs ( 1992:211 ) U n d e r s t a n d i ng a l i f e e v e n t s u c h a s p r e g n a n c y a s r e q u i r i ng m e d i c a l a tt e n t i o n o r s p e c i a l i zed m e d i c a l ca r e i s a p a r t o f t h e m e d i c a l i za t i o n p r o ce s s U n d e r t h i s d e f i n i t i o n i t d o e s n ot m a tt er w h e t h e r o r n ot a m e d i c a l i s s ue i s s ee n a s l e g i t i m a t e ; e v e n c r i t i ca l a n d l i f e s a v i ng in t e r v e n t i o n i s a p a r t o f m e d i c a l i z a t i o n a s t h e u n d e r s t a n d i ng a n d t r ea t m e n t h a v e a l l b e e n c o n s t r u c t e d w i t h i n a m e d i c a l f r a m ew o r k. M o s t o f t e n h o we v e r p e o p l e a r e r e f e r r in g t o o v e r m e d i c a l i z a t i o w h e n t h e y u s e t h i s t e r m a n d a r e f o c u s e d o n w h e t h e r o r n o t u n d e r s t a n d i ng ce r t a i n e v e n t s t h r o ugh t h i s m e d i c a l i ze d l e ns i s a l w a y s a pp r o p r i a t e. E vid e n c e of M e di c a l i z a t ion in Wo m e n s E x p e r i e n ces I n o r d e r to u n de r s t a n d w hy m e d i c a l i za t i o n mi g h t p r e s e n t a p r o b l e m f o r p e o p l e g i v i ng b i r t h i t i s n ec e ss a r y t o e x a mi ne h o w t h e p r o ce s s o f m e d i c a l i za t i o n c a n d i r ec t l y i m p act s o m e o n e s e x p e r i e n ce M e d i ca l in t e r v e n t i o n m a y r e s t r i c t in d i v i du a l s i n b o t h l i t e r a l a nd m e t a p h o r i c a l w a y s F o r e x a m p l e m a ny h o s p i t a l p o l i c i e s r e q u i r e t h a t w o m e n do n ot e a t d u r in g l a b o r b eca u s e o f t h e p o ss i bil i t y o f C S ec t i o n W hile t hi s m a y m a ke

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9 s e n s e f r o m a m e d i c a l s t a n dp o in t l a b o r m a y l a s t m a ny h o u r s a n d i s a n e x t r e m e ly in t e n s e b od i ly e x p e r i e n c e w h e r e l a r ge a m o u n t s o f c a l o r i e s a r e b e i ng u s e d. T h i s r e q u i r e m e n t m a y m a ke l a b o r a m o r e u n c o m f o r t a b l e p r o ce s s f o r t h e in d i v i d u a l a n d r e li e s o n t h e n o t i o n t h a t C s ec t i o n i s a l w a y s a r ea s o n a bly e x p ec t ed p o s s i bi l i t y f o r b i r t h C o n t in u o us f e t a l m o n i t o r in g or a n I V m a y l im i t a p e r s o n s a bil i t y t o m o v e T h e s e in t e r v e n t i o n s a r e n o t n ece s s a r y f o r l o w r i s k b i r t h s a n d m a y c o n f i ne m o v e m e n t du r in g p a r t s o f t h e i r l a b o r w h e r e s i tt in g s t il l i s u n c o m f o r t a b l e C e r t a i n d r ugs a d mi n i s t e r e d m a y a l s o l im i t a p a t i e n t s a b i l i t y to m o v e du r in g l a b o r F o r e x a m p l e e p i du r a l s m a y p r e v e n t in d i v i d u a l s f r o m b e i ng a b l e to m o v e t h e i r l e g s a n d b eca u s e o f t h i s r e g u l a t i o n i s o f t e n p l ace d by t h e h o s p i t a l o n w h e t h e r a n in d i v i d u a l c a n l ea v e t h e i r b e d o r n ot a f t e r r ece i v i ng a n e p i du r a l E ac h o f t h e s e a s p ec t s o f p o s s i b l e b i r t h i ng e x p e r i e n ce s s h o w s p a l p a b l e r e s t r i c t i o n s b e i ng p l a ce d o n t h e b i r t h i ng b od y a n d t h e i r i m p ac t o n t h e in d i v i du a l s e x p e r i e n c e i s a ff e c t e d by h o w c o m f o r t ab l e ( o r u n c o m f o r t a b l e ) t h e y a r e w i t h r ec e i v i ng t h e s e in t e r v e n t i o n s R e s t r i c t i o n o f m o v e m e n t i s a l s o e v i d e n t i n t h e c o m m o n h o s p i t a l b i r t h in g p o s i t i o n w h e r e a p a t i e n t li e s o n t h e i r b ac k w i t h t h e i r l e g s s p r ea d op e n T h i s p o s i t i o n i s a d v a n t a g e o us f r o m a m e d i c a l s t a n dp o in t a s i t a l l o w s d o c to r s g r e a t vi s i b il i t y o f a n d ac c e s s to t h e v a g i n a l c a n a l b ut s t ud i e s h a v e s h o w n t h a t t h i s m a y n o t b e t h e b e s t p o s i t i o n f o r g i v i ng b i r t h p r e f e r r in g i n s t ea d a s t a n d in g o r s qu a t t i n g p o s i t i o n ( G up t a a n d H o f my e r 2004; M i c h e l 1, R a k e T r e i b e r S e i f e r t C h a o u i H u c h M a r in ce k a n d K u b i k H u c h 2002 ) B eca u s e o f t h e a u t h o r i t a t iv e n a t u r e o f m e d i c a l s e t t in g a n d s o c i e t a l e x p ec t a t i o ns o f p o l i t e f e m i n i n i t y m a ny w o m e n m a y n o t r e qu e s t a d i ff e r e n t p o s i t i o n o r e v e n r ec o gn i z e t h a t d e v i a t in g f r o m t h e h o s p i t a l n o r m i s a n o p t i o n ( M a r t i n 2003 ) T h i s r e l a t i o n s h i p b e t wee n t h e s t a n d a r d h o s p i t a l b i r t h i ng p o s i t i o n a n d l ac k o f p e r c e i v e d

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10 a b i l i t y t o d e v i a t e f r o m h o s p i t a l n o r m s evidence restriction as a c o m b i n a t i o n o f t a n g i b l e a n d in t a n g i b l e f o r ce s T h e in c r ea s e d u s e o f l a b o r in d u c t i o n a n d au g m e n t a t i o n t h r o ugh d r ugs i s a n o t h e r a s p ect o f t h e h o s p i t a l b i r t h i ng e x p e r i e n c e w h i c h c o m e s und e r s c r u t i ny i n c r i t i qu e s o f h o s p i t a l b i r t h i ng ( B ec k e tt 200 5 ) I f s o m e o n e i s c o n s i d e r e d to h a v e go n e too f a r p a s t t h e i r due d a t e o r h a s b e e n i n l a b o r f o r too l o n g w i t h a f a i l u r e to p r o g r e ss t h e y a r e o f t e n g iv e n a d r ug w h i c h w i ll s t im u l a t e c o n t r a c t i o n s M o s t t i m e s t h i s d r ug c o m e s i n t h e f o r m o f P i t o c in a s yn t h e t i c O x y t o c in T h i s m e t h o d o f in d u c t i o n i s o f t e n c r i t i q u e d b e ca u s e o f f ea r s t h a t d o c to r s m a y b e in du c i ng l a b o r p a r t i a lly b a s e d o n t h e i r o w n n ee ds ( e g. wa n t in g t he l a b o r n ot to t a ke t o o l o n g wa n t in g to s c h e d u l e pa t i e n t s b i r t h ) i n s t ea d o f a l w a y s b e i ng u s e d i n ca s e s w h e r e i t i s a n ece ss i t y D r ugs f o r i ndu c t i o n a r e a l s o o f t e n li nk e d to a ca s ca de o f in t e r v e n t i o n s i n w h i c h b e g i n n i ng in t e r v e n t i o n s i n c r e a s e t h e li k e l ih oo d f o r u s e o f f u r t h e r a n d m o r e e x t r e m e m e d i c a l in t e r v e n t i o n ( G o e r 1999; R o s e n t h a l 2006 ) T h i s a r g u m e n t i s s upp o r t e d by r e s ea r c h w h i c h h a s s h ow n t h a t w o m e n w ho h a v e t h e i r l a b o r s a u g m e n t e d o r in du ce d w i t h m e d i ca t i o n m a y b e a t a g r e a t e r r i s k f o r C e s a r e a n S ec t i o n ( C a mm u, M a r t e n s R u y s s i n c k, a n d A my 2 002; H e ff n e r E l k i n, a n d F r e t t s 2003 ) C r i t i qu e s o f e a c h o f t h e s e c o m m o n in t e r v e n t i o n s highl i g h t s o m e po t e n t i a l i ss u e s t h a t m a y a r i s e f r o m m e d i c a l i ze d t r e a t m e n t s o f b i r t h H o we v e r t h e u s e o f t h e s e in t e r v e n t i o ns i s r e l a t iv e ly r ece n t i n h i s t o r i c t e r m s T r a c in g s h i f t s i n t h e h i s t o r y o f b i r t h a n d b i r t h m a n a g e m e n t g iv e s in s i g ht in t o c h a n g e s i n t h e w a y s o ur s o c i e t y i n g e n e r a l t hi n ks a b o ut b i r t h I t a l s o h i g hl i g h t s h o w a n d w hy in t e r v e n t i o n s d i s c u s s e d w i t h i n t h e s ec t i o n r o s e to p o pu l a r i t y w i t h i n t h e m e d i c a l m o d e l o f b i r t h in g ca r e.

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11 A B r i e f Hi s t o r y o f M e di c a l i z a t i o n in B i r t h S i g n i f i c a n t s hi f t s i n u n d e r s t a n d i ng o f p r e g n a n c y a nd b i r t h t h r o ugh a m e d i c a l l e n s h a ve t a k e n p l ac e o v e r t im e I t h a s b e e n a r gu e d t h a t a g r e a t d ea l o f t h i s s h i f t to o k p l ac e b e t wee n t he 17 t h a n d 18 t h c e n t u r y a s b i r t h b e g a n t o m o v e f r o m t h e o ut o f h o s p i t a l s e tt in g in t o t h e h o s p i t a l, though this shift is representative of a very early understanding of when the medicalization of birth began to take place ( C a hill 2000 ) T h i s s h i f t wa s a ss o c i a t e d n o t o n l y w i t h c h a n g e s i n t h e w a y t h a t b i r t h a n d p r e g n a n c y we r e u n d e r s to o d, b ut a l s o i n w h o wa s s ee n a s a n a u t h o r i t y a n d t h e b e s t ca r e p r o v i d e r C a h i ll p o in t s to t h e i n v e n t i o n a n d s p r ea d i n t h e u s e o f f o r ce ps a s a m a j o r e v e n t i n t h e s hi f t to t he h o s p i t a l s e tt in g, a s w e l l a s s o c i e t a l i d e a l s t h a t s c i e n ce a s o pp o s e d to e x p e r i e n c e a n d k n ow l e dg e b a s e d t r a i n i ng s h ou l d b e t h e g u i d i ng p r ac t i c e i n c h il d b i r t h C o n t a in e d w i t h i n t h i s a r g u m e n t a r e s o m e i m p li c a t i o n s a b o ut t h e w a y s t h a t t h e m e d i c a l i z a t i o n o f b i r t h h a s a ff ec t e d t h e g e n d e r e d n a t u r e o f b i r t h i ng ca r e W h e t h e r or n o t o n e b e l i e v e s t h a t t h e p r ac t i c e s o f mi d w i v e s du r in g t h i s t im e f r a m e we r e b e tt e r o r w o r s e t h a n t h e ca r e f r o m t h e m o r e i n s t i t u t i o n a l i z ed s ph e r e s o f m o de r n m e d i c i n e i t ca n n o t b e f o r g ott e n t h a t w o m e n we r e o r i g i n a lly d i s a l l o we d t he e du ca t i o n n ec e ss a r y t o b ec o m e a m e d i c a l p r o f e ss i o n a l t h e r e f o r e e l im i n a t in g w o m e n l e d ca r e i f i n s t i t u t i o n a l p r o f e ss i o n a l s we r e to b ec o m e t h e v a l u e d m o d e l f o r b i r t h in g. B eca u s e w o m e n we r e b a rr e d, in d i v i du a l s w h o h a d p r e v i ou s k n ow l e d g e i n b i r t h i ng ca r e t r a d i t i o n a lly a p o s i t i o n o cc up i e d by a w o m a n we r e a l s o e l im i n a t e d f r o m th i s p r o f e s s i o n C a h i ll f u r t h e r e x p l i c a t e s g e n d e r e d i ss u e s w i t h i n t h e s h i f t t o t h e h o s p i t a l s e tt in g n o t in g t h a t w o m e n a t t h i s t im e a l o n g w i th t h e poo r we r e c o n s i d e r e d a pp r o p r i a t e ca n d i d a t e s f o r r e s ea r c h a n d t eac h i ng m a t e r i a l s m a k i ng t h e i r b od i e s

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12 e ff ec t iv e ly l e s s v a l u e d o n a n a u t o n o m o us l e v e l C a h i ll a r gu e s t h a t d e s p i t e t h i s e x p l o i t a t i o n s o c i e t a l f e a r s s i n c e t h e 18 t h c e n t u r y h a ve f o c u s e d o n n o t h a v i ng a d o c t o r p r e s e n t a t a b i r t h h i s t o r i c a lly a m a l e d o c to r a n d t h a t t hi s f ear c o m b i n e d w i t h t h e d e v a l u a t i o n o f mi d w i v e s h a s h e l p e d to pu s h o b s t e t r i c ca r e a l m o s t e n t i r e ly in t o t h e h o s p i t a l i n s t i t u t i o n C a h i ll c o n c l ud e s t h a t t hi s h a s h e l p e d l ea d t o t h e p a t h o l o g i z i ng a n d m e d i c a l i za t i o n o f p r e g n a n c y a n d t h a t t h e li m i t a t i o n o f mi dw i f e r y t o l o w r i s k p r e g n a n c i e s i s a n u n d e r u t ili z a t i o n o f t h i s p r o f e s s i o n T h i s d i s c u s s i o n a l s o i l l u mi n a t e s t h e d i f f i c u l t y in u n d e r s t a n d i ng t h e h o s p i t a l s p h e r e a s a p o s t g e n d e r o r f e m i n i ne i n s t i t u t i o n T h i s i s p a r t i c u l a r ly r e l e v a n t g i v e n t h e c u rr e n t s h i f t i n t h e n u m b e r o f m e n a n d w o m e n s t ud yi ng t o b ec o m e O B / GYN s w i t h w o m e n n o w acc o u n t in g f o r a l a r ge m a j o r i t y o f r e s i d e n t O B / GYN s ( Ge r b e r a n d S a ss o 2006 ) H o we v e r i t i s im p o r t a n t to c o n s i d e r h o w t h e h i s t o r i c a lly m a l e a n d m a s c u li ne d o mi n a t e d i n s t i t u t i o n m a y s t il l b e s h a p e d by p r e vi o us s e x i s t a t t i t ud e s a n d p r ac t i c e s a n d n o t e t h at t h i s p h e n o m e n o n o f m a j o r i t y w o m e n a s O B / GY N s i s r e l a t i v e ly r ec e n t i n h i s t o r i c a l t e r m s Other authors have pointed to major shifts t o the hospital setting as taking place at a later time than is suggested by Cahill. According to Devitt (1977) the major shift to the hospital realm occurred in the mid portion of the 20 th century, where in hospital birthing increased from around 37% in 19 35, to 88% in 1950, to 96% in 1960. While the medical model may have been gaining popularity and making advances in technology well before this time, as discussed by Cahill, these statistics evidence that relatively rapid transition from mostly out of hos pital birthing to a near complete reliance on the hospital model. to a variety of factors, including the rise of industrialization and urbanization in the

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13 h outcomes, the growing influence of infectious disease theory, the virtual elimination of midwife care, and growing understandings of pregnancy as a medical problem which required doctor care. Greater class and geographic accesses also contributed to ulti mate shifts to the hospital setting, as birthing outside of the hospital was associated with lack of access to hospital care, either because of finances or location. Devitt notes, however, that this shift was not necessarily associated with safety, because although data from the time does show greater chances for poor birth outcomes from the out of hospital setting, it does not control for socioeconomic condition, which has been shown to contribute to poor birth outcomes. In turn, Devitt argues that this sh ift was based in changing conceptions Thomasson and Treber (2008) point to changes in the infrastructure of the hospital which lead to the transformation of common birth setting within the U nited States. They argue that in the beginning of the 20 th century hospital became the centers of medical science, and that advances in medical technology and a growing consumer base d octors opted to work within the hospital, instead of primarily through house calls, for this first t ime. These authors point to a similar period of time when discussing the rise in hospital birth, and also examine maternal mortality, which they say was not significantly decreased by hospital birthing. Instead, they argue that it was the physicia ns preference for the hospital environment and the ir promotion of this environment, which most greatly contributed to the shift from out of ho spital birth to hospital birth. T h e s h i f t f r o m t h e o u t o f h o s p i t a l s e tt in g to t h e h o s p i t a l a n d t h e m e d i c a l i za t i o n

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14 a ss o c i a t e d w i t h i t ca n be s e e n i n c h a n g i ng p u b li c op i n i o n s s u rr o u n d in g b i r t h K K B a k e r ( 1998) f o c u s e s o n h o w t h e r h e t o r i c s u rr o u n d in g p r e g n a n c y h a s p r o v i d e d e v i d e n c e o f t h i s c h a n ge i n s o c i e t y s u n d e r s t a n d in g s o f p r e gn a n c y a n d b i r t h w hi l e a t t h e s a m e t im e r e i n f o r c in g a n d p e r p e t u a t in g t h i s m e d i c a l i z e d u n d e r s t a n d i ng. B a k e r p o in t s to m e d i ca l t e x t s f r o m t h e ea r l y 20 th ce n t u r y r e l a t e d to p r e g n a n c y a n d e x a m i n e s h o w t h e y r e g u l a t e d a n d c r ea t e d a n o r m a l i zed d e f i n i t i o n o f t h e c o n d i t i o n o f p r e g n a n c y a s a w h o l e I n p a r t i c u l a r t h e U n i t e d S t a t e s C h il d r e n B u r ea u s Pr e natal C a r e a t e x t f i r s t pub li s h e d i n 1 913 a n d d i s t r ib u t e d to t e n s o f m il l i o ns o f w o m e n i n t h e ea r ly p o r t i o n o f t h e t we n t i e t h c e n t u r y s e r v e s a s a r e p r e s e n t a t i o n o f t h e s p r ea d o f m o r e m e d i ca li z e d u n d e r s t a n d in g s o f p r e gn a n c y T h i s h a n d b oo k s t yl e t e x t w o r k e d a s a s o r t o f h o w t o f o r p r e g n a n c y o u t li n i ng d e c i s i o n m a k in g h y g i e n e a n d p o t e n t i a l c o m p l i c a t i o ns of p r e g n a n c y. B a k e r e x a m i n e s t w o e d i t i o ns o f t h e t e x t t h e 1924 a n d t h e 1935, i n o r d e r to h i g hl i g h t h o w Pr e natal C a r e e mb od i e s b i o m e d i c a l r h e t o r i c a b o ut p r e g n a n c y a s i t wa s f i r s t in t r o du ce d to w o m e n ( 1998:1069 ) T h e l a n gu a g e c o n s t r u c t s p r e g n a n c y u n d e r a d i s ea s e m o d e l d o mi n a t e d by l a ngu a ge a n d c o n t e n t t h a t r e p e a t e d l y c a s t a l l p r e g n a n c i e s a s p o t e n t i a lly pa t h o l og i c a l po t e n t i a lly d i s ea s e li k e ( 1998:1069 ) T h i s d i s e a s e m o d e l i s e v i d e n t m o s t l y t h r o ugh d e p i c t i o n s o f p r e g n a n c y a s a h o s t p a r a s i t e r e l a t i o n s h i p ( e g. d i s c u ss in g t h e b a by t a k in g f r o m t h e m o t h e r s b od y ) a n d t h r o ugh h i g hl i g h t in g t h e po t e n t i a l f o r t hi ngs t o g o w r o n g i n p r e g n a n c y a t a ny t im e. T h e t e x t a l s o h i g h li g h t s t h e n ee d f o r r e li a n c e o n do c t o r s a n d m e d i ca l i n s t r u m e n t a t i o n t h e n eed f o r li m i t a t i o n a n d c o n t r o l o f s e lf due t o p r e g n a n c y a n d t h e d i s m i s s a l o f a l t e r n a t iv e f o r m s o f k n ow l e dg e s u c h a s r e li a n c e o n b od i ly a w a r e n e s s a n d f o l k k n ow l e dg e.

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15 B a k e r a l s o n o t e s d i ff e r e n c e s b e t wee n t h e t w o t e x t s f o c u s in g o n t h e f ac t t h a t t h e 1935 e d i t i o n c a l l s f o r m o r e in d i v i du a l d e f e r e n c e to m e d i c a l p r o f e s s i o n a l s t h a n t h e 1924 e d i t i o n The societal elev ation of the authority of medical professionals i s e x e m p li f i e d by : t h e f i r s t e d i t i o n e x a mi n e d wa s w r i tt e n by a w o m a n w i t h c hi l d r e n w hi l e t h e s ec o n d e d i t i o n wa s w r i tt e n by a m e d i c a l d o c t o r T h i s s h i f t i n e x p e r t r o l e o f t h e t e x t c o m b i n e d w i t h t h e in c r e a s e d i n f l u e n c e o f m e d i c i ne o n t h e l a t e r t e x t acc o r d in g t o B a k e r h i g hl i g h t s t h e t r e n d t o wa r ds t h e m e d i c a l i za t i o n o f p r e g n a n c y I t i s a l s o e v i d e n c e o f g r ea t e r v a l ue b e i ng p l ace d o n l ea r n e d k n ow l e dge o f b i r t h a n d p r e g n a n c y ( i e t h a t w h i c h i s g a i n e d i n m e d i ca l s c h oo l a n d a s a d o c to r ) v s li v e d k n ow l e d g e ( i e a dv i c e f r o m s o m e o n e w h o h a s g iv e n b i r t h ) w h i c h t i e s i n t o C a hil l s d i s c u ss i o n o f t h e e x p e r t r o l e s hi f t in g t o t h e m e d i c a l s p h e r e a n d aw a y f r o m li v e d e x p e r i e n c e. M e di c a l i z a t ion and So c ial C on t r ol T h e p r e v i o us d i s c u s s i o n b e g i ns t o i l l u m i n a t e t h e w a y s m e d i c a l i z a t i o n h a s a ff ec t e d o ur c u l t u r e : i n s h o r t, m e d i c a l i za t i o n f u n c t i o n s a s a f o r m o f s o c i a l c o n t r o l T h e r e s t r i c t i o n o f m o v e m e n t a n d ea t in g du r in g l a b o r o r t h e m e s s a g e s a b o ut a n o r m a l p r e g n a n c y c o n v e y e d t h r o ugh t e x t s m a tt e r a s a w h o l e b eca u s e t h e y c o mm u n i ca t e m e s s a g e s a b o ut t h e p r o ce s s o f p r e g n a n c y a n d b i r t h w h i c h i m p ac t h o w o ur s o c i e t y t h in k s a b o ut t h e s e i s s u es T h e s e m e s s a g e s a l s o i n f l u e n c e h o w in d i v i du a l s w h o a r e p r e g n a n t a n d bi r t hin g a r e a b l e to f u n c t i o n w i t h i n o ur s o c i e t y B eca u s e p r e g n a n c y a n d b i r t h a r e m o s t o f t e n a ss o c i a t e d w i t h c i s w o m e n t h e s e m e d i c a l i zed u n d e r s t a n d i n g s a l s o ca rr y g e n d e r e d m e ss a g i ng, a nd i n t u r n t h e i r c o n t r o l m a y h a v e d i r ect g e n d e r e d im p l i c a t i o n s

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16 U n d e r s t a n d i ng t h e w a y s o b s t e t r i c ca r e ca n b e u s e d a s a f o r m o f s o c i a l c o n t r o l e s p e c i a lly a s i t i s r e l a t e d to g e n d e r h e l p s c l a r i f y w hy t h e m e d i c a l i za t i o n o f p r e g n a n c y m a y b e p r o b l e m a t ic f o r s o m e i n d i v i d u a l s W h e n c o n s i d e r in g c r i t i qu e s a ss o c i a t e d w i t h m e d i c a l i z a t i o n s u c h a s t he d e v a l u a t i o n o f f e mi n i n i t y t h e p a t h o l og i z i ng o f p r e g n a n c y a n d r i s i ng m e d i ca l in t e r v e n t i o n r a t e s i t i s e ss e n t i a l t o f o c us n o t o n l y o n h o w i s s u e s c a m e to e x i s t w i t h i n t h e m e d i c a l f r a m ew o r k, b ut a l s o h o w t h e y a ff ec t p e o p l e a t b o t h t h e s o c i e t a l l e v e l ( s u c h a s t h e i r u n d e r s t a n d i ngs o f t he e x p e r i e n c e o f p r e g n a n c y ) a n d a l s o t h e in d i v i d u a l l e v e l ( f o r e x a m p l e t h e i r s a t i s f ac t i o n w i t h t h e b i r t h in g e x p e r i e n ce ) W e c a n r e t u r n to C a h i ll ( 2000 ) w h o s e w o r k a l s o f o c u s e s o n h o w t h e m e d i c a l i za t i o n o f c hi l d b i r t h h a s b ec o m e a f o r m o f s o c i a l c o n t r o l I n p a r t i c u l a r h e r t h e o r i e s f o c us o n t h e s p e c i f i cs o f h o w c hi l d b i r t h h a s b e e n m e d i c a l i ze d a n d h o w t hi s p r o ce s s to o k s h a pe i n a h i s t o r i c a l f r a m e w o r k. C a hi l l a r gu e s t h a t m e d i c a l f r a m e s o f r e f e r e n c e a n d k n ow l e dge h a ve b ee n acce p t ed a n d l e g i t im a t e d w i t h i n a s y s t e m t h a t h a s b r o ug h t a b o ut n ot o n l y a s u r ge i n e n g i n ee r i ng o b s t e t r i cs b ut a s t ea d y e r o s i o n o f m a t e r n a l c h o i ce c o n t r o l a nd s a t i s f ac t i o n i n r e l a t i o n to m a ny a s p ec t s o f p r e g n a n c y a n d l a b o u r ( 200 0:334 335 ) C a h i l l s a r g u m e n t a l s o f o c u s e s o n t h e g e n d e r e d i m b a l a n c e t h a t t h i s s y s t e m c r ea t e s S h e h i g h li g h t s t h e f ac t t h a t t h e r e i s n o c o m p a r a b l e m a l e a s s i g n e d m e d i c a l s y s t e m w hi l e a r g u i ng t h a t t h e s y s t e m i n p l a c e p r o v e s to f u r t h e r p a t h o l og i z e p r e g n a n c y a n d mi n im i z e t h e p o we r a n d a u t o n o m y o f w o m e n w hi l e b o l s t e r in g t h e p o we r o f w h a t s he a r gu e s i s t h e p r e d o mi n a n t l y m a l e s p h e r e o f m e d i c i n e T h i s c o n t r o l i s p r im a r i ly m a in t a i n e d t h r o ugh r e gu l a t i o n o f t h e p r e g n a n t b o dy v i a m e d i c a li ze d u n d e r s t a n d i n g s o f p r e g n a n c y a nd m e d i c a l in t e r v e n t i o n w h i c h r e li e s o n t h e s e u n d e r s t a n d i n g s

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17 I n f u r t h e r e x a m i n a t i o n o f t h e w a y s w h i c h m e d i c a li za t i o n a n d i t s a ss o c i a t e d in t e r v e n t i o ns a r e d i r ec t l y r e l a t e d to s o c i a l c o n t r o l w e ca n r e t u r n to a n ea r li e r e x a m p l e o f t h e u s e o f p a i n r e li e v i ng m e d i c i ne du r in g l a b o r T h e u s e o f p a i n r e l i e v i ng d r ugs a l s o p l a y s a l a r ge r o l e i n t h e lim i t a t i o n o f m o v e m e n t A s m e n t i o n e d ea r li e r a f t e r r ece i v i ng a n e p i du r a l a p a t i e n t w i ll o f t e n b e ph y s i ca l ly i n ca p a b l e o f s t a n d i ng o r m o v i ng o u t s i de o f t h e h o s p i t a l b e d, m a k i ng a s t a n d i ng o r s qu a t t in g b i r t h im p o s s i b l e T h i s l i m i t a t i o n b ec o m e s p a r t i c u l a r l y r e l e v a n t w h e n c o n s i d e r in g t h a t 61% o f a l l w o m e n b i r t h i ng s i n g l e b a b i e s n o w r ec e iv e a n e p i du r a l o r s o m e o t h e r f o r m o f s p i n a l a n e s t h e t i c ( Na t i o n a l V i t a l S t a t i s t i c s R e p o r t 201 1 ) W hi l e e p i du r a l s m a y b e a v a l u e d a n d i m p o r t a n t p a r t o f t h e b i r t h e x p e r i e n c e f o r s o m e in d i v i du a l s o n e s t udy h a s s h o w n t h a t e p i du r a l u s a ge m a y b e r e l a t e d to h i g h e r f e a r o f ch i l d b i r t h a nd e x p e r i e n ce s o f l o s s o f c o n t r o l i n t h e b i r t h s e t t in g, b ut n ot g r e a t e r u n d e r s t a n d in g o r k n o w l e d g e o f e p i du r a l s ( H e i n z e a n d S l e i g h 2003 ) T h i s e v i d e n c e s i ss u e s w i t h l ac k o f i n f o r m e d c o n s e n t a nd h o w i t mi g h t b e p r o b l e m a t i c w h e n c o m b i n ed w i t h r ea d i e d a n d acc e s s i b l e m e d i c a l in t e r v e n t i o n a s w e l l a s h o w t h e u s e o f t h e in t e r v e n t i o n m a y b e a s s o c i a t e d w i t h f ea r o f t h e p r o ce s s o f b i r t h a n d t h e p o s i t i o n i ng o f b i r t h a s an u n n a t u r a l e v e n t w h i c h m u s t b e m a n a g e d v i a m e d i c i n e P a i n i s p o s i t i o n e d a s a s ca r y a n d un m a n a g ea b l e p a r t o f l a b o r in s t ea d o f a s a n a t u r a l o cc u rr e n ce a n d t h e e p i du r a l b ec o m e s t h e m e d i c a l i z e d s o l u t i o n t o t h e p r o b l e m o f p a in I n o r d e r to f u r t h e r u n d e r s t a n d t h e w i d e s p r ea d u s a g e o f e p i du r a l s A r n e y a n d N e i ll ( 2008) d i s c u s s h o w p a i n m a n a g e m e n t a n d u n d e r s t a n d i ngs o f p a i n h a v e b e e n d i r ec t l y r e l a t e d to t he c o n s t r u c t i o n o f t h e h o s p i t a l b i r t h e x p e r i e n c e o v e r t h e p a s t ce n t u r y T h e a u t h o r s a r gue t h a t m u c h o f t h e f o c us o f o b s t e t r i c s h a s b e e n r e l a t e d to p a in : f i r s t f o c u s e d o n p a i n e l im i n a t i o n a n d t h e n o n p a i n m a n ag e m e n t T h e y e v e n n o t e t h a t

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18 f o r s o m e t im e u s i ng p a i n m a n a g e m e n t f o r c h il d b i r t h wa s c o n s i d e r e d t a b o o a n d t h a t b e f o r e t h e 1 9 t h c e n t u r y p a i n wa s c o n s i d e r e d a n a t u r a l a n d n o r m a l e x p e r i e n ce T h i s r ec o n s t r u c t i o n o f t h e e x p e r i e n c e o f p a i n du r in g l a b o r m a y c u l t i v a t e f ea r i n t h e b i r t h in g e nv i r o n m e n t a n d p r o m o t e m o r e in d i v i du a l r e l i a n c e o n m e d i ca t i o n i n o r d e r to a v o i d p a in I t a l s o h i g hl i g h t s t h e e ff ec t s t h a t m e d i ca li z a t i o n h a s had o n c r ea t in g s o c i e t a l n o r m s A s i n d i v i du a l s b e g a n to s e e p a i n m a n a g e m e n t du r in g b i r t h a s n e c e s s a r y a ss u m p t i o ns a b o ut t h e ca p a b i l i t y o f b od i e s ( a n d i n p a r t i c u l a r w o m e n s b od i e s ) a r o s e O n a n in d i v i d u a l l e v e l t h e se a ss u m p t i o n s m a y i n f l u e n c e a n in d i v i du a l in t o t h i n k in g t h e y a r e n o t ca p a b l e o f h a n d l i ng t h e e x p e r i e n c e o f b i r t h or t h a t t h e y s h ou l d a u t o m a t i c a lly a t t e m pt to f i t h e p a i n a s s o c i a t e d w i t h l a b o r u s in g in t e r v e n t i o n. W hi l e t h e a u t h o r s a r gue t h a t t h e n a t u r a l b i r t h i ng m o v e m e n t h a s i m p ac t e d t h e s h i f t f r o m e l im i n a t i o n to m a n a g e m e n t t h e r e a r e in t e r e s t in g im p l i ca t i o n s a b o ut c u rr e n t p a i n m a n a g e m e n t m e t h o ds w h e n e x a m i n i ng p r e v i o us m e t h o ds o f p a i n e l im i n a t i o n O n e m e t h o d o f p a i n e lim i n a t i o n w h i c h wa s p o p u l a r i n t h e ea r l y 2 0 t h c e n t u r y wa s a m ix t u r e o f m o r ph i ne a n d s c o p o l a mi n e a h ea vy c o m b i n a t i o n o f d r ugs w h i c h b l o c k e d m e m o r y f o r m a t i o n a n d s e n s a t i o ns o f p a i n w i t h o ut ca u s in g c o m p l e t e u n c o n s c i o u s n e s s ( B ec k e t t 2005 ) T h i s m e t h o d o f p a i n e l im i n a t i o n r e f e rr e d to as t w i l i g h t s l ee p m a y h a v e k e pt t h e p a t i e n t p h y s i c a lly a wa k e b ut a l s o p u t w o m e n i n a n a l t e r ed a n d u n awa r e s t a t e a n d m a d e i t s o t h a t r ec o ll ec t i o n o f b i r t h wa s e n t i r e l y i m p o s s i b l e T h i s p r ac t i c e i s n o l o n g e r u s e d, b ut h i g hl i g h t s t h e f ac t t h a t m e d i c a l a n d c u l t u r a l u n d e r s t a n d in g s o f t he b e s t wa y m a y s hi f t o v e r t im e a n d a l l o w f o r a g r ea t e r p r ece d e n t f o r qu e s t i o n in g c u rr e n t l y acce p t e d p r a c t i c e s J u s t b eca u s e a n o r m i s e s t a bl i s h e d i n a s e tt in g o f g r ea t c u l t u r e a u t h o r i t y i n t h i s c a s e w i t h i n t h e m e d i c a l f i e l d, d o e s n ot m e a n t h a t i t w i ll n o t b e l a t e r q u e s t i o n e d a n d r ee x a m i n e d by t h e s a m e i n s t i t u t i o n

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19 A s p r e v i ou s ly d i s c u s s e d, B a k e r ( 1998) e x a m i n e s t e x t s f o c u s in g o n m e d i ca li z a t i o n o f p r e g n a n c y a n d b i r t h a n d t h e m e ss a g e s s e n t a b o u t w o m e n t h e i r b od i e s a n d t h e i r ca p a bil i t i e s T h i s t y pe o f m e ss a g i ng i s p a r t i c u l a r ly i m p o r t a n t f o r i n f l u e n c i ng o ur s o c i e t y r e f l ec t in g a n d a l s o s h a p i ng c u l t u r e n o r m s s u rr o u n d in g b i r t h a n d p r e gn a n c y M u c h li ke B a k e r M a r s h a l a n d W oo ll e t t ( 2000) u s e p r e g n a n c y t e x t s to e x a mi ne w h a t m e s s a g e s a b o ut p r e g n a n c y a n d b i r t h a r e c o nv e y e d. W hi l e t h i s s t u d y i s U K b a s e d a n d t h e r e f o r e b a s e d o n t e x t s f r o m t h i s r e g i o n t h e w o r k s t il l il l u mi n a t e s t h a t m e d i c a l i z e d u n d e r s t a n d i n g s o f p r e g n a n c y a r e c o n t in u e d w i t h i n c o n t e m p o r a n e o us p r e g n a n c y t e x t s a im e d a t e x p ec t a n t m o t h e r s L i k e B a k e r t h e a u t h o r s f in d pa tt e r n s o f t h e t e x t s i n s t r u c t in g w o m e n to d i s c i p l i ne t h e i r b od y i n c e r t a i n w a y s o f t e n t r e a t in g t h e in d i v i du a l a s s o m e o n e w h o d o e s n ot k n o w a b o u t o r u n d e r s t a n d t h e e x p e r i e n c e w h i c h i s h a p p e n in g t o t h e m T h e t e x t s a t t im e s a l s o c o n s t r u c t e d t h e p r e g n a n t i n d i v i du a l a s o u t o f c o n t r o l b o t h ph y s i ca l ly a nd e m o t i o n a ll y f u r t h e r e m p h a s i z i ng t h e n ee d f o r r e gu l a t i o n a n d o b s e r v a t i o n by s o m e o n e i n a p o s i t i o n o f k n ow l e dg e o r e x p e r t i s e I n a d d i t i o n t o m e d i ca li z i ng t h e e x p e r i e n c e o f b i r t h a n d p r e g n a n c y t h e s e t e x t s a l s o o f t e n s t r e s s t h e i d e a o f a n o r m a l p r e g n a n c y e x p e r i e n c e T h e y h i g hl i g h t a n o r m a l c h il d g i v e n b i r t h i n t h e n o r m a l s e tt in g: t h e h o s p i t a l T h i s n o r m a l i z i ng o f t h e p r e g n a n c y e x p e r i e n c e c r ea t e s an i d e a l i ze d v e r s i o n o f p r e g n a n c y w h i c h m a y ca u s e c o n s u m e r s to b e f ea r f u l o r c o n ce r n e d w h e n t h e i r o w n p r eg n a n c y d o e s n ot m ee t t h i s s t a n d a r d. B eca u s e o f t h e t e x t s ( a n d t h e l a r g e r s o c i e t a l ) p r e s e n t a t i o n o f p r e g n a n c y b e i ng t r e a t e d i n t h e m e d i c a l r e a lm t h i s m a y i n s t i g a t e a f u r t h e r r e li a n ce o n m e d i c a l p r o f e ss i o n a l s i n o r d e r to i n s u r e t h a t e v e r y t h in g i s r i g h t a n d n o r m a l I n m a ny w a y s t h e t e x t s s t ud i e d by t h e a u t h o r s r e i n f o r c e t h e i d e a o f a p r e g n a n t w o m a n a s s o m e o n e w h o

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20 n ee d s a g r ea t de a l o f h e l p i n h e r p r e g n a n c y m a i n ly h e l p f r o m t h e s e m e d i c a l p r o f e s s i o n a l s w h o a r e u n d e r s t o o d a s ac t u a l ly k n ow in w h a t i s g o i ng o n T h e ca s e o f m e d i c a l i za t i o n i n p r e g n a n c y t e x t s ill u m i n a t e s t h e p e r v a s i ve n a t u r e o f t h i s d i s c o u r s e i n o ur s o c i e t y a n d g iv e s s o m e in s i g h t in t o h o w h o s p i t a l b i r t h i ng c a m e t o b e s i t u a t e d as t h e r i g h t w a y t o b i r t h i n o ur m a s s s o c i e t y I n p a r t i c u l a r t h i s t h e s i s i s f o c u s e d o n e x a mi n i ng t h e w a y s c o n t r o l a n d e m p o we r m e n t mi g h t b e a ff ec t e d by t h i s m e d i ca li z a t i o n M e d i c a l i z a t i o n i s a r gu e d to b e a s o c i a l p r o ce ss w h i c h m a y h a v e d i r e c t i m p l i c a t i o ns f o r in d i v i du a l e x p e r i e nce s of c o n t r o l a n d e m p o we r m e n t ( C a h i ll 2011; M a r s h a l & W oo ll e t t 2000 ) I n o r d e r to a t t e m pt to e x a m i ne c o n t r o l a n d e m p o we r m e n t i n t h e b i r t h p l a ce i t i s n ec e ss a r y t o c r e a t e a c l e ar u n d e r s t a n d i ng o f t h e s e t e r m s a n d d i s c u s s h o w t h e y m a y b e r e l a t e d to t h e p h e n o m e n o n o f m e d i c a l i za t i o n C on t r o l Va r i o us s t ud i e s h a ve f o u n d t h e a bil i t y t o e x e r t c o n t r o l o v e r t h e e x p e r i e n c e o f o n e s b i r t h i s i m p o r t a n t f o r w o m e n s s a t i s f ac t i o n w i t h t h e i r b i r t h a s a w h o l e ( B a k e r C h o i He n s h aw a n d T r e e 2005; G r ee n a n d B a s t o n 2003; L in dg r e n 2010; P a r r y 2008 ) B r ea c h e s i n t h e e x p e r i e n c e o f c o n t r o l h a ve also b e e n f ou n d to be associated with p r o b l e m a t i c e x p e r i e n c e f o r b i r t h in g i n d i v i d u a l s ( L i ndg r e n a n d E r l a n d s s o n 2010 ) T h i s r e s ea r c h s h o w s t h a t f o r m a ny p e o p l e t h e a bi l i t y t o e x e r t c o n t r o l o v e r d i ff e r e n t a s p ec t s o f t h e i r b i r t h i s a m e a n i n g f u l p a r t o f t h e ir c o n ce p t i o n o f t h e e x p e r i e n c e a n d m e a n i n g f u l t o t h e i r a bil i t y t o a c t a s a n a g e n t i c b e i ng. De s p i t e t h e im p o r t a n c e o f c o n t r o l i n b i r t h i t i s n ec e ss a r y t o n o t e t h a t t h e r e a r e s o m e d e f i n i t i o n a l i s s u e s w i t h t h e t e r m M an y r e s ea r c h e r s d o n ot f u lly a r t i c u l a t e w h a t t h e y m e a n w h e n u s in g t h e t e r m c o n t r o l ( N a m e y a n d L y e r ly 2010; C a r t e r 2010 ) This

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21 necessitates defining h o w c o n t r o l i s b e i ng r e f e rr e d to i n a s t u d y a s w e l l a s i t s im p o r t a n c e to t h e p a r t i c i p a n t s J o s p e h i ne M G r ee n a n d H e l e n A B a s t o n ( 2 0 03) b r ea k c o n t r o l in t o t h r e e s e p a r a t e c a t e g o r i es w h e n u t ili z i ng t h e t e r m i n t h e i r s t udy a b o ut b i r t h : t h e i r r e s ea r c h f o c u s e s o n c o n t r o l o v e r o n e s b e h a v i o r c o n t r o l du r in g c o n t r a c t i o n s a n d c o n t r o l o v e r s t a f f T h e s e ca t e g o r i e s t o u c h o n b o t h in t e r n a l a n d s e l f c e n t e r e d v i s i o n s o f c o n t r o l a s w e l l a s e x t e r n a l c o n t r o l b e i ng e x e r t e d o n t h o s e a r o u n d t h e p a r t i c i p a n t T h e s t udy u l t im a t e l y h i g hlig h t s t h a t t h e c o n s t r u c t i o n o f ea c h m ea s u r e o f c o n t r o l by p a r t i c i p a n t s wa s im p o r t a n t to t h e i r s a t i s f ac t i o n i n t h e b i r t h i ng e x p e r i e n ce l e n d i ng to t h e n o t i o n t h a t t h e v a r i o us a n d c o ll e c t i ve e x pe r i e n c e o f c o n t r o l i s a m e a n i n g f u l p a r t o f b i r t h T h e i r r e s ea r c h also helps to c o n s t r u c t a m o d e l f o r b e g i nn i ng to u n d e r s t a n d t he d i ff e r e n t a r t i c u l a t i o ns o f c o n t r o l i n t h i s s t u d y I t h i ghl i g h t s n ot o n l y c o n t r o l o v e r d e c i s i o n m a k i ng, b ut a l s o h o w t h e p a r t i c i p a n t i s f ee li ng a b o ut t h e i r a b i l i t y t o c o n t r o l t h e i r s e lf a n d s o m e o f t h e i n v o l u n t a r y p h y s i c a l a s p e c t s o f l a b o r I n a n d o f i t s e l f b i r t h i s a un i que e x p e r i e n c e w i t h r e g a r ds to c o n t r o l W hi l e t h e g e n e r a l a bil i t y t o c o mm a n d r e s p ec t a n d a u t h o r i t y i n d e c i s i o n m a k in g r e l a t e d to o n e s b od y m a y c r ea t e a m o r e p o s i t i ve s p ac e f o r b i r t h i ng, o n e ca n n o t i g n o r e t h e ph y s i ca l r e a l i t i e s o f t h e i n v o l u n t a r y n a t u r e o f b i r t h U n l e s s o n e e l e c t s f o r a p l a n n e d C e s a r ea n S ec t i o n w h e n t h e b i r t h in g p r o ce s s w i ll s t a r t ca nn o t b e k n o w n T h e r e a r e a l s o v a r i o us a s p e c t s o f b i r t h w h i c h a r e m o s t l y o ut o f in d i v i du a l c o n t r o l s u c h a s w h e n o n e s wa t e r w i ll b r ea k, h o w l o n g t h e i r l a b o r w il l l a s t h o w l o n g t h e i r c o n t r a c t i o n s w ill b e a n d w h e n t h e i r c o n t r ac t i o n s w ill b e I t i s i n p a r t b eca u s e o f t h i s t h at S h a n n o n K C a r t e r ( 201 0 ) a r gu e s t h a t w o m e n m a y c o n s t r u c t t h e m s e l v e s a s b e i ng b o t h i n a n d o ut o f c o n t r o l w hi l e b i r t h i ng, a n d m a y e v e n e x p r e s s vi ew s w h i c h do n ot m a t c h d e f i n i t i o n s o f c o n t r o l s u c h a s r ec o gn i t i o n o f t h e i n v o l u n t a r y n a t u r e o f ce r t a i n a s p ec t s o f b i r t h A tt e n t i o n to t h e

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22 c o m p l e x n a t u r e o f c o n t r o l i n t h e b i r t h i ng e x p e r i e n ce s h e l ps t o h i g hl i g h t t h e un i que e x p e r i e n c e o f b i r t h a n d d r aw s o u t t h e s e p a r a t e u n d e r s t a n d in g s o f c o n t r o l o v e r d e c i s i o n m a k in g, e m o t i o n a l a n d m e n t a l s t a t e a n d a b i l i t y to d o w h a t o n e wa n t s i n t h e i r b i r t h f r o m c o n s t r u c t i o n s o f c o n t r o l r e l a t e d to t he w a y a n in d i v i du a l c o n ce p t u a li z e s t h e i r b i r t h i ng b od y a n d t h e e n t i r e p h e n o m e n o n o f b i r t h. E m po w e r m e nt W hi l e t h e t e r m e m p o we r m e n t o f t e n l ac k s a c l ea r d e f i n i t i o n t h r o ug h o u t lit era ture on the subject i t s e e m s t o b e u n d e r s t o o d a s a n in d i v i du a l s a bi l i t y t o d e r iv e f e e l i ngs o f p e r s o n a l p o we r f r o m t h e i r b i r t h in g e x p e r i e n ce S o m e f i n d i n g s h i g hl i g h t t h e i n t e r c o nn ec t ed n e s s o f e m p o we r m e n t a n d c o n t r o l i n b i r t h a n d h o w t h e e x p e r i e n c e s m a y g o h a n d i n h a n d f o r m a ny i n d i v i d u a l s F o r e x a m p l e t h e ab il i t y t o c o n t r o l o n e s b i r t h ha s b e e n d i r ec t l y c o n n ec t e d i n r e s ea r c h to f e e li n g s o f e m p o we r m e n t i n t h e b i r t h s e tt in g ( C h e y n e y 200 8 ; L in dg r e n a n d E r l a n d s oo n 2010 ) H o we v e r t h e r e a r e o t h e r wa y s e m p o we r m e n t m a y be f o s t e r e d i n t h e b i r t h i ng e nv i r o n m e n t t h a t h a v e l e s s to do w i t h t h e p e r s o n a l e x p e r i e n c e o f c o n t r o l R e s ea r c h h a s s h o w n t h a t s uppo r t i n t h e b i r t h s e tt in g h a s a n i m p ac t o n in d i v i du a l s s a t i s f ac t i o n w i t h t h e ir b i r t h a s a w h o l e a n d c a n i n t u r n l ea d t o e x p e r i e n c e s o f e m p o we r m e n t ( B a k e r e t a l 2005; B e r g a n d T e r s t a n d 2006; F o x a n d W o r t s 1999; L in dg r e n a n d E r l a n d s s o n 2010; P a rr y 200 8 ; Z a d o r o z n y j 2001 ) K n ow l e dge h a s also b ee n f o u n d to b e a s o u r c e o f e m p o we r m e n t ( C h e y n e y 2008) f u r t h e r h i g hl i g h t in g t he i m p o r t a n c e o f i n f o r m e d c o n s e n t a s a w a y to ac h i e ve e m p o we r m e n t ( S t o c k il l 2007 ) m p o we r m e n t i n a s i t u a t i o n m a y b e d i r ec t l y c o nn ec t e d to t h e i r a bil i t y t o

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23 b e i n c o n t r o l ( C h e y n e y 200 8 ; L i ndg r e n a n d E r l a n d s oo n 2010 ) A bil i t y t o m a ke d e c i s i o n s a n d e ff ec t iv e ly e x e r t c o n t r o l m a y a f f ec t h o w p o we r f u l a n i n d i v i d u a l f e e l s H o we v e r s e p a r a t e u n d e r s t a n d i n g s o f e m p o we r m e n t a n d c o n t r o l a r e n ece s s a r y a s e x p e r i e n ce s o f e m p o we r m e n t can g iv e s o m e u n i q u e in s i g h t in t o t h e b i r t h i ng e x p e r i e n c e w h i c h m a y n o t b e e v i d e n t w h e n j u s t e x a m i n i ng c o n t r o l F o r in s t a n ce p o we r i n t h e b i r t h s e t t in g i s s o m e t h in g w h i c h c ou l d b e c o n ce p t u a li ze d i n pu r e l y p h y s i ca l t e r m s ; t h e ac t o f g i v i ng b i r t h i s o n e w h i c h o f t e n r e q u i r e s a g r eat d e a l o f s t r e n g t h a n d s t a mi na ( C h e y n e y 2008 ) T h i s a s p ec t o f p o we r a n d b i r t h i s p a r t i c u l a r l y r e l e v a n t g i v e n t h a t f e m a l e b od i e s a r e o f t e n p o s i t i o n e d a s b e i ng wea k e r and less capable in t h e b i r t h s e tt in g ( M a r t in 2003 ) I n d i v i du a l s m a y not n ece s s a r i ly f e e l i n c o n t r o l o f t h e i n v o l u n t a r y p r o ce ss e s o f t h e i r b od y i n b i r t h b ut t h e y m a y s t i ll r ec o gn i z e t h e a m o u n t o f s t r e n g t h, a n d t h e r e f o r e p o we r t h a t i s a s s o c i a t e d w i t h t h e i r ac t o f b i r t h i ng. I n d i v i d u a l s m a y e x p e r i e n c e e m p o we r m e n t b eca u s e t h e y h a v e p h y s i c a lly o v e r c o m e t h e s e i d e a s a b o ut t h e i r s t r e n g t h t h r o ugh t h e ph y s i c a l ac t o f b i r t h i ng. H o we v e r ph y s i c a l s t r e n g t h i n l a b o r i s n o t t h e o n l y w a y t o c o n ce p t u a li z e t h e e x p e r i e n c e o f e m p o we r m e n t i n b i r t h. T h i s s t u d y f o cu s e s o n e x a m i n i ng t h e po t e n t i a l d i ff e r e n c e s i n e x p e r i e n c e s o f e m p o we r m e n t b e t wee n in d i v i du a l s w h o h a v e b i r t h e d w i t h i n t h e h o s p i t a l a n d t h o s e w h o h a ve b i r t h e d o u t o f t h e h o s p i t a l P r e v i o us t h e o r i s t s h a v e a r gu e d t h a t t h e o u t o f h o s p i t a l s e tt i n g i s p a r t i c u l a r l y a d e pt a n d f a c il i t a t in g e x p e r i e n ce s o f c o n t r o l a n d e m p o we r m e n t f o r b i r t h in g w o m e n ( C a hill 201 0 ; C a r t e r 2010 ; S h a w a n d K i t z i ng e r 2005 ) H o we v e r t h e l ac k o f d a t a c o ll ec t e d f r o m h o s p i t a l pa r t i c i p a n t s a n d l ac k o f c o m p a r a t iv e s t u d y p r o v i d e s a ga p i n t h e l i t e r a t u r e w h i c h n ee d s to b e f i l l e d. A d d i t i o n a l l y t h i s s t udy w ill a tt e m pt to a pp r o ac h b i r t h in g w i t h i n a h o s p i t a l f r o m a m o r e t h i r d wa ve f e m i n i s t

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24 p o s i t i o n which focuses more on p a r t i c i p a n t n a rr a t i v e s a n d t h e f l u i d i t y o f c h o i c e s a n d i d e n t i t i e s t h a n p r e v i o us l i t e r a t u r e h a s T h i s position in c l ud e s r ec o gn i z i ng p r e f e r e n c e f o r m e d i c a l i za t i o n a s a v a l i d c h o i ce j u s t a s b i r t h i ng o u t o f h o s p i t a l i s a v a l i d c h o i c e ( B ec k e t t 2005 ) I n acc o r d a n ce t h e n e x t s ec t i o n w i ll e x a m i ne c r i t i ca l ly b o t h t h e o u t o f h o s p i t a l s e t t in g, a n d s o m e i s s u e s w i t h p r e v i o us r e s e a r c h i n t h e s t u d y o f b i r t h Ho s pi t al or Ou t o f Ho s pi t a l : C on t r o l E m po w er m e n t and t he B i r t hing S e tt ing I t h a s b ee n a r gu e d t h a t o u t o f h o s p i t a l mi dw i f e a ss i s t e d b i r t hs a r e a d i r ec t r e s i s t a n c e to t h e m e d i c a l i ze d m o d e l o f h o s p i t a l b i r t hs ( B ec k e t t a n d H o f f m a n 2005; C h e y n e y 200 8 ; P a r r y 2008 ; Z a d o r o z n y j 2001 ) a n d t h e a l t e r n a t iv e c hi l d b i r t h m o v e m e n t i n N o r t h A m e r i c a c a n be t r ace d b ac k to t h e l a t e 1960 s a n d ea r l y 1970 s a s a d i r ec t r e s p o n s e to m e d i c a l i ze d c o n ce p t i o n s o f c hi l d b i r t h ( B ec k e t t 2005; P a r r y 200 8 ; Z w e i g a n d O l i v e r 2009 ) W i t h i n t h i s m o d e l o f ca r e g r ea t e r e m p h a s i s i s p l a ce d o n a v o i d i ng m e d i ca l in t e r v e n t i o n p o s i t i o n i ng b i r t h a s a t u r a l h e n o m e n o n a n d f o s t e r in g a m o r e d i r ec t i n v o lv e m e n t o f w o m e n w i t h t h e p r o ce s s o f t h e i r b i r t h ( A n n a n d a l e 198 8 ; B ec k e t t a n d H o ff m a n 2005 ) B eca u s e o f c r i t i qu e s r e l a t in g to e m p o we r m e n t a n d c o n t r o l i n t h e m e d i c a l m od e l o f c hi l d b i r t h s o m e a u t h o r s h a ve a r gu e d t h a t t h e m i dw i f e m o d e l f o s t e r s g r ea t e r a g e n c y a n d e m p o we r m e n t ( C h r i s t i a e n s Va n D r V e l d e a n d B r ack e 201 1 ; P a rr y 2008; St o c k i ll 200 7 ) T h e r e i s a l s o e v i d e n c e t h a t t h e m i dw i f e m o d e l o f c a r e i s p a r t i c u l a r l y a d e pt a t c r ea t in g c l o s e r e l a t i o n s h i p s b e t we e n w o m e n a n d t h e mi d w i f e ( L i ndg r e n a n d E r l a n d ss o n 2008 ; P a r r y 2008) a n d b u i l d i ng i n f o r m e d c o n s e n t w i t h p a t i e n t s ( P a r r y 200 8 ; C h e y n e y 2008 ) T h i s i s n o t to s a y h o we v e r t h a t t h e r e i s n o t the p o t e n t i a l f o r c r i t i que w i t h i n t h e

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25 mi d w i f e m o d e l P r e v i o us c r i t i c s h a v e p o in t e d to t h e h o w o u t o f h o s p i t a l b i r t hs m a y p r i vi l e ge n o n m e d i ca t e d b i r t h a s b e i ng i nh e r e n t l y b e tt e r t h a n t h e a l t e r n a t i ve ( B ec k e tt 20 0 5 ) T h is privileging of non medicated birthing m a y b e p r o b l e m a t i c b e ca u s e i t c r ea t e s a d i ff e r e n t b u t s t i ll e x i s t e n t r i g h t w a y to b i r t h O t h e r c r i t i qu e s h a v e f o c u s e d o n t h e f ac t t h a t t h e mi d w i f e m o d e l o f ca r e i s o f t e n r e li a n t o n v e r y r i g i d u n d e r s t a n ds o f f e m i n i n i t y e v e n i f t h e y a r e s e e n a s p o s i t iv e u n d e r s t a n d i n g s s u c h a s i nh e r e n t m a t e r n a l a bil i t y ( B ec k e tt 200 5 ) P o s i t i o n i ng o ut o f h o s p i t a l b i r t h a s e ss e n t i a lly e m p o we r in g m a y a l s o im p ly t h a t h o s p i t a l b i r t h c a n n o t b e o r i s l e s s li k e l y t o b e e m p o we r in g. W hi l e t h e s e i d e a l s do n o t n ece ss a r ily p e r p e t u a t e a n e g a t iv e v i e w o f w o m e n t h e y do p r e s e n t a h e g e m o n i c v i e w o f w o m e n a n d m a y c r ea t e d i f f i c u l t y i n s i t u a t i o n s i n w h i c h a r e c i p i e n t of c a r e d o e s n ot m a t c h p r e s c r ib e d d e f i n i t i o ns o f f e m i n i n i t y O n e o f t h e b i g g e s t c r i t i qu e s o f t h e o u t o f h o s p i t a l m o d e l h a s t o d o w i t h t h e r a c i a l a n d c l a s s b a s e d d i v i de i n r e c i p i e n t s o f ca r e W hi l e r a t e s f o r h o m e b i r t h a n d o ut o f h o s p i t a l b i r t h i n g e n e r a l h a v e i n c r ea s e d, w h i t e w o m e n h a v e t h e m o s t h o m e b i r t h s a n d t h e i r r a t e s o f h o m e b i r t h h a v e i n c r ea s e d m o r e d r a m a t i c a lly ( M acD o r m a n M e n acke r a n d De c l e r c q 2010; M a cD o r m a n M a t h ew s a n d De c l e r c q 2012 ) I t h a s b e e n a r gu e d t h a t t h e o u t o f h o s p i t a l b i r t h i ng m o v e m e n t l i ke o t h e r r e p r o du c t iv e m o v e m e n t s h a s b e e n p a r t i c u l a r ly t a i l o r e d to t h e n ee ds o f w h i t e mi d d l e c l a s s w o m e n T h i s focus o n white, middle class women m a y b e due i n p a r t to t h e c o n s u m e r c h o i c e n a rr a t iv e w h i c h h a s b e e n a ss o c i a t e d w i t h o u t o f h o s p i t a l b i r t h i ng ( C r a v e n 2010 ) T h i s n a rr a t i ve f o c u s e s o n c h oo s in g b i r t h a s t h e b e s t c o n s u m e r o p t i o n a n d t h o ugh t h i s c o n s u m e r i s t a t t i t ud e i s n o t u n c o m m o n i n h o s p i t a l s ( Z a d o r o z n y j 2001 ) i t a l s o d o e s l i tt l e t o r e m e d y t h e f a c t t h a t w o m e n o f c o l o r a n d po o r w o m e n i n t h e U n i t e d S t a t e s h a v e c o n t in u e d to s t r ugg l e f o r acce s s

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26 to qu a l i t y r e p r o d u c t i v e ca r e b o t h i n a nd o u t o f t h e h o s p i t a l ( 2010:8 ) T h e consumer choice n a rr a t iv e often d o e s n ot ac k n ow l e dge t h e d i ff e r e n t s t a r t i n g p o we r t h a t in d iv i du a l s m a y h a v e w h e n n a v i g a t in g t h e ca p i t a li s t m a r k e t p l a ce T h e im a ge o f t h e o u t o f h o s p i t a l b i r t h i ng m o t h e r h a s a l s o b e e n a l a r g e l y w h i t e wa s h e d o n e ( C r a v e n 2010 ) L ac k o f d iv e r s i t y i n t h e p o pu l a t i o n o f o ut o f h o s p i t a l m o t h e r s a s w e l l a s t h e m o v e m e n t s r e p r e s e n t a t i o n o f w h a t a n o u t o f h o s p i t a l m o t h e r i s m a y f u r t h e r s e r ve to a li e n a t e p e o p l e o f c o l o r f r o m t h i s m o v e m e n t T h e a ss u m p t i o n t h a t eac h in d i v i du a l e n t e r s in t o b i r t h w i t h t h e s a m e a m o u n t o f p o we r a n d c h o i c e i s a f l awe d o n e in d i v i du a l s m a r g i n a l i ze d i d e n t i t i e s m a y h a v e a h uge im p ac t o n t h e p o we r a n d c o n t r o l t h a t t h e y a r e g r a n t e d w i t h i n a s e tt in g, p a r t i c u l a r l y i f i t i s d o mi n a t e d by i n d i v i du a l s w i t h m o r e p r i vi l e g e d i d e n t i t i e s The various critiques and possible benefits of each birthing environment must be considered when attempting to study individual experience within these settings. Currently, many of the studies focused on midwifery and care recipient experiences are internationally based (Christiaens et al. 2008; Lindgren and Erlandsson 2008;Parry 2008), and more focus needs to be placed on capturing how the U.S. midwife model function. While t h e r e a r e s o m e U S. s t ud i e s w h i c h f o c us o n t h e e x p e r i e n c e s o f w o m e n in s i de o f h o s p i t a l s ( G r ee n a n d B a s t o n 2003) t h e r e i s a l ac k o f qu a l i t a t iv e w o r k w h i c h c o m p a r e s t h e e x p e r i e n c e s o f d i f f e r e n t b i r t h in g e x p e r i e n c e s i n p a r t i c i p a n t s o w n v o i c e s T hi s lack of qualitative work is p a r t i c u l a r ly p r o b l e m a t i c b eca u s e i t s h o w s a l ac k o f li v e d e x p e r i e n c e b e i ng d e v o t e d to u n d e r s t a n d i ng w h e t h e r o r n ot i ss u e s o f c o n t r o l a n d e m p o we r m e n t a r e a c t u a l ly i n e x i s t e n ce s u c h a s t h o s e d i s c u s s e d by C a hill ( 2001 ) W hi l e i ss u e s o f c o n t r o l a n d e m p o we r m e n t a r e o f t e n t h e ce n t e r p o i nt o f

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27 t h e s e s t u d i e s w e l a c k e n o ugh i n d i v i d u a l n a rr a t i v e s to t r u l y u n d e r s t a n d t h e li v e d e x p e r i e n ce T h ese narratives are e s p e c i a lly r e l e v a n t f o r a t t e m p t in g t o u n d e r s t a n d h o w e x p e r i e n c e s of control and empowerment v a r y ac r o s s d i f f e r e n t s e t t in g s W hi l e t h e r e i s s o m e U S. b a s ed qu a l i t a t iv e w o r k i n ea c h in d i v i du a l s e tt in g ( S e e C h e yn e y 2008 f o r o u t o f h o s p i t a l ) t h e r e i s s t i ll a l ac k o f s t u d i e s w h i c h u t ili z e d qu a l i t a t iv e in t e r v i e w s f o r b o t h h o s p i t a l a n d o u t o f h o s p i t a l b i r t h s ( C a r t e r 2010 i s o n e e x a m p l e ) T h i s lack s h o w s a n e e d f o r c o n t in ue d q u a l i t a t iv e w o r k i n t h e r e a l m o f h o s p i t a l b i r t h i ng i n o r d e r to c r e a t e a m o r e c o m p l e t e n a rr a t iv e a s w e ll a s t h e n ee d f o r m o r e qu a l i t a t iv e c o m p a r a t i ve s t ud i e s o f h o s p i t a l a n d o u t o f h o s p i t a l b i r t h s A c o m p a r a t iv e s t u d y w i ll a l l o w f o r a m o r e n u a n ce d p i c t u r e o f t h e e x pe r i e n c e s o f p o we r a n d c o n t r o l a s w e l l a s h o w t h e s e e x p e r i e n c e s m a y o r m a y n o t d i ff e r b e t wee n o ut o f h o s p i t a l a n d h o s p i t a l b i r t h s I n p a r t i c u l a r i t i s i m p o r t a n t to c o m p a r e t h e s e p o pu l a t i o n s i n o r d e r to s e e how much of an effect m e d i c a l i za t i o n o n e x p e r i e n c e s o f p o we r a n d c o n t r o l While t h e s e p r o b l e m s w i t h t h e c r i t i qu e s o f m e d i c a l i za t i o n a n d m e d i ca li z e d b i r t h i ng e x i s t b i r t h d o e s n ot occur i n a v ac u u m T h e r e i s s t i ll t h e a u t h o r i t y a s s o c i a t e d w i t h t h e h o s p i t a l m o d e l, w h i c h h e l ps t o c r e a t e a n a u t h o r i t y g a p b e t we e n m e d i c a l d o c to r s a n d mi d w i v e s W e li ve i n a c u l t u r e w h i c h i s d o mi n a t e d by m e d i c a l d i s c o u r s e a n d a d v i c e f r o m d o c t o r s c o m e s w i t h deference O u t o f h o s p i t a l b i r t h i ng, h o we v e r i s n o t t h e s o c i e t a l n o r m a n d i n d i v i d u a l s w h o s ee k t h i s ca r e a r e s t e pp in g o u t s i d e o f t h e n o r m a n d r e j ec t in g m e d i c a l i ze d s t a n d a r d s C r i t i q u e s o n t h e h o s p i t a l model are critiques on the most common form of care, which is at no risk for dissolution or damage from attempt to uncover potential issues or sugg est alternative care settings

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28 III M ET HO D O L OGY Da t a we r e d e r iv e d f r o m in t e r v i e w s w i t h 16 pa r t i c ip a n t s w h o c o m p r i s e d t w o d i f f e r e n t s u b s a m p l e s t h e h o s p i t a l s a m p l e a n d t h e o u t o f h o s p i t a l s a m p l e E ac h s u b s a m p l e h a d e i g ht p a r t i c i p a n t s S e l ec t i o n c r i t e r i a s t a t e d t h a t w o m e n m u s t h a v e g i v e n b i r t h w i t h i n t h e l a s t y ea r a t t h e d a t e o f t h e i r in t e r v i ew p r e f e r e n c e wa s g iv e n t o w o m e n w h o h a d b i r t h e d w i t h i n t h e p a s t 6 m o n t h s T h i s c r i t e r i o n wa s put i n p l ac e b ecau s e i t wa s b e l i e v e d t h a t m o r e r ece n t b i r t h s w ou l d a l l o w p a r t i c i p a n t s to ac h i e v e g r ea t e r r e c o ll ec t i o n of d e t a il s o f t h e b i r t h wh i c h m a y b e l o s t w i t h t im e C r i t e r i a a l s o s t a t e d t h a t t h e p a r t i c i p a n t s m u s t h a v e l a b o r e d w i t h e i t h e r a n O B / GY N i n t h e h o s p i t a l s e tt in g, o r a mi d w i f e i n t h e h o m e o r a t a b i r t hin g h o m e Ha v i ng a t l e a s t o n e t y pe o f t h e s e ca r e p r o v i d e r s du r in g p r e g n a n c y a n d l a b o r wa s n e c e ss a r y f o r t h i s s t u d y a s in t e r ac t i o n w i t h ca r e p r o v i d e r i s w h e r e a g r ea t d e a l o f t h i s r e s ea r c h wa s f o c u s e d. W o m e n w h o p l a n n e d to g iv e b i r t h i n t h e h o s p i t a l s e tt in g a n d ac c i d e n t a l ly g a v e b i r t h a t h o m e we r e n o t acce p t ed a s t h e b i r t h e x p e r i e n c e f e ll o u t s i de o f t h e n o r m f o r e i t h e r t h e i n h o s p i t a l o r o u t o f h o s p i t a l b i r t h i ng c o mm u n i t y a n d t h e r e wa s n o in t e r ac t i o n w i t h a ca r e p r o v i d e r du r in g l a b o r O n e p a r t i c i p a n t wa s acce p t e d w h o r ece iv e d p r e n a t a l ca r e f r o m a n d l a b o r e d w i t h a mi d w i f e b u t u l t im a t e l y g a v e b i r t h u n a s s i s t e d. A l t h o ugh t h i s wa s n o t i n h e r p l a n s he s t i ll h a d in t e r ac t i o n w i t h a mi d w i f e du r i ng t he m a j o r i t y o f h e r l a b o r a n d a l l o f h e r p r e g n a n c y a n d h a d p l a n n e d to g iv e b i r t h a t h o m e m e a n i ng t h a t t h e s e a s p ec t s s t i ll w e i g h e d h e a vily o n h e r e x p e r i e n ce T w o p a r t i c i p a n t s w h o h a d to t r a n s f er o u t o f h o s p i t a l t o t h e h o s p i t a l mi d l a b o r we r e a l s o acce p t e d, a s t h e i r in t e r ac t i o n w i t h b o t h e nv i r o n m e n t s wa s c o n s i d e r e d a v a l u a b l e a s s e t to t h e s u b s a m p l e

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29 Re c r ui t m e nt R ec r u i t m e n t f o r t h i s s t udy w a s m u l t i f a ce t e d. U l t i m a t e ly t h e v a s t m a j o r i t y o f t h e p a r t i c i p a n t s we r e f o u n d t h r o ugh e i t h e r a c o n t a c t m a de a t o n e o f t h e a r e a b i r t h i ng h o m e s w o r d o f m o u t h f r o m i n d i v i du a l s w h o h ea r d a b o ut m y s t u d y a n d k n e w s o m e o ne t h e y t h o ug h t mi g h t be in t e r e s t e d, a n d s n ow b a ll s a m p li ng, i n w h i c h I a s k e d eac h o f my p a r t i c i p a n t s i f t h e y k n e w a n y o ne t h e y t h o ug h t mi g h t b e in t e r e s t e d i n p a r t i c i p a t in g. O f g r ea t i m p o r t a n c e f o r s a m p l i ng wa s my c o n t a c t a t t h e a r e a b i r t h i ng h o m e a s this contact p r o v i d e d m e w i t h a ll b ut o n e o f m y o u t o f h o s p i t a l b i r t h p a r t i c i p a n t s a n d t h r e e o f m y h o s p i t a l b i r t hing p a r t i c i p a n t s A d d i t i o n a ll y f l y e r s we r e p l ace d i n a r e a s w h e r e m o t h e r s w h o h a d y o u n g c hi l d r e n mi g h t b e s u c h a s a t o y s t o r e a c o mm u n i t y c o ll e ge c a m p u s a n d l o c a l c o ff e e s h o p s De s p i t e t h e u s e o f d o ze n s o f f l y e r s t h i s m e t h o d wa s l ea s t e ff ec t iv e r e s u l t in g i n o nly t w o r e s p o n s e s a n d o n e in t e r v i ew I b e li e v e t h a t t h i s h a d t o d o w i t h t he f ac t t h a t i t mi g h t b e ea s y f o r in d i v i du a l s t o l o s e t h e s li ps o f p a p e r w h i c h h a d my i n f o r m a t i o n on i t a n d b eca u s e in d i v i du a l s m a y h a v e f e l t l e s s c o m f o r t a b l e c o n n ec t in g w i t h s o m e o n e w h o t h e y h a d n o r e f e r e n c e f o r a n d h a d n e v e r m e t P a r t i c ipant De m og r aphi c s I n m y f i n a l t w o s u b s a m p l e s p a r t i c i p a n t s we r e b e t wee n t h r e e wee ks a n d e i g h t a n d a h a l f m o n t h s p o s t p a r t u m M o s t o f m y p a r t i c i p a n t s we r e f i r s t t im e m o t h e r s b ut n u mb e r s o f p r e v i ou s c hi l d r e n r a n g e d f r o m ze r o to t h r ee E i g h t o f m y p a r t i c i p a n t s h a d h a d o ut o f h o s p i t a l b i r t h s w hi le e i g h t h a d i n h o s p i t a l b i r t h s I n ea c h s u b s a m p l e b i r t h in g a n d o v e r a ll p r e g n a n c y e x p e r i e n c e v a r i e d g r ea t l y L a b o r r a n g e d f r o m q u i c k a n d r e l a t iv e ly p a i n f r ee to l o n g a n d v e r y p a i n f u l w h il e p r e g n a n c i e s v a r i e d f r o m b e i ng

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30 d e s c r ib e d a s e n j o y a b l e to i n c r e d i bly d i ff i c u l t a n d m e d i c a lly c o m p l i ca t e d. O f t h e o u t o f h o s p i t a l b i r t h s a l l b ut o n e p a r t i c i p a n t h a d h e r b i r t h t h r o ugh o n e o f t he l o c a l b i r t h i ng h o m e s T h e o t h e r p a r t i c i p a n t h a d a h o m e b i r t h w i t h a mi d w i f e w h o r a n a p r iv a t e h o m e b i r t h p r ac t i ce n o t a ss o c i a t e d w i t h a n y o f t h e l o ca l b i r t h i ng h o m e s S e v e n o f my p a r t i c i p a n t s g a v e b i r t h a t h o m e w h il e o n e g a v e b i r t h i n t h e ac t u a l b i r t h i ng c e n t e r M y y o u n g e s t o u t o f h o s p i t a l pa r t i c i p a n t wa s 2 3 a n d t h e o l d e s t wa s 36. T h e m e a n a ge f o r t hi s s u b s a m p l e o f p a r t i c i p a n t s wa s 29. S e v e n o f my p a r t i c i p a n t s i d e n t i f i e d a s w h i t e o r C a u ca s i a n w hi l e 1 p a r t i c i p a n t i d e n t i f i e d a s H i s p a n i c A ll p a r t i c i p a n t s s e l f i d e n t i f i e d t h e i r g e n d e r a s f e m a l e i g hl i g h t in g a b i n a r y c o n f l a t i o n o f s e x a n d g e n d e r w i t h i n t h e s u b s a m p l e O f t h e h o s p i t a l b i r t h p a r t i c i p a n t s a l l h a d v i s i t e d O B s w i t h i n a b i c o u n t y a r ea a n d h ad g iv e n b i r t h a t t h r e e d i f f e r e n t a r e a h o s p i t a l s F o u r of t h e p a r t i c i p a n t s d e li v e r e d v a g i n a ll y w hi l e f o ur h a d C e s a r e a n s ec t i o n T h e y o u n g e s t h o s p i t a l p a r t i c i p a n t wa s 22, w h il e t h e e l d e s t wa s 31. T h e m e a n a ge w a s a b o ut 2 7 S i x o f t h e p a r t i c i p a n t s i d e n t i f i e d a s w h i t e o r C a u ca s i a n w hi l e o n e i d e n t i f i e d a s H i s p a n i c a n d o n e a s A f r i c a n A m e r i c a n L i ke t h e o u t o f h o s p i t a l s a m p l e a l l o f my p a r t i c i p a n t s i d e n t i f i e d t h e i r g e n d e r a s f e m a l e

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31 T a b l e 1: D e m o g r a ph i c s f o r O u t o f H o s p i t a l S a m p le N am e A ge R a ce ( S e l f Id e n ti f i e d) # o f P r e v i o us Ch il d r e n S e tt i n g A m a n da 31 W h i t e / C a u c a s i an 0 H o m e J e ss i c a 25 W h i t e / C a u c a s ian 0 H o m e K y r a 23 W h i t e / C a u c a s i an 3 H o m e L o r e l e i 29 W h i t e / C a u c a s i an 1 H o m e L o r o 34 W h i t e / C a u c a s i an 0 H o m e M a r y 36 W h i t e / C a u c a s i an 2 H o m e N i c o le 27 W h i t e / C a u c a s ian 1 H o m e S a r ah 27 H i s p a n ic 0 B i r t h H o m e T a b l e 2: D e m o g r a ph i c s f o r H o s p i t a l S a m p l e N am e A ge R a c e ( S e l f Id e n t i f i e d) # o f P r e v i o us Ch il d r e n T r a n s f e r r e d t o H o s p ita l d u r i ng L a b o r ? V a g i n a l o r C s ec ti o n A li c e 22 A f r i ca n A m e r i can 0 No V a g i n a l A n n e 26 W h i t e / C a u c a s i an 1 No C s ec ti o n A u b r e y 26 W h i t e / C a u c a s ian 0 No V a g i n a l C h a r l o tte 27 W h i t e / C a u c a s i an 0 Y es V a g i n a l M i a 29 W h i t e / C a u c a s i an 1 No C s ec ti o n M i c h e lle 28 W h i t e / C a u c a s i an 2 No V a g i n a l N i n a 25 H i s p a n ic 1 Y es C s ec ti o n Ta b a t ha 31 W h i t e / C a u c a s i an 0 No C s ec ti o n

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32 I n t e r vi ew / A n a l y s is P r o c e ss S e m i s t r u c t u r e d in t e r v i e w s we r e c o n du c t e d w i t h a ll p a r t i c i p a n t s I n f o r m e d c o n s e n t was o b t a in e d f r o m ea c h p a r t i c i p a n t p r i o r to b e in g in t e r v i ewe d. I u t i l i z e d a s e t s h ee t o f qu e s t i o ns a s a g u i de f o r in t e r v i e w s I t f ea t u r e d p r o m p t s f o r a l l p a r t i c i p a n t s a s w e l l a t qu e s t i o ns a im e d a t s p e c i f i c e nv i r o n m e n t s a n d s p e c i f i c ca r e p r o v i d e r s H o we v e r t h e in t e r v i e w p a t h wa s n o t c o n c r e t e, a n d t h e r e f o r e I d i d n o t a s k t h e s a m e q ue s t i o n s o f e v e r y p a r t i c i p a n t I n t e r v i e w i ng wa s b a s e d i n g r o u n d e d t h e o r y ( B a bb i e 2007; G l a s e r a n d S t r a u s 1967; S t r a us a n d C o r bin 1998 ) A s s u c h qu e s t i o ns we r e a dd e d a n d e l im i n a t e d du r in g t h e d a t a c o ll ec t i o n p r o ce s s b a s e d o n t h e a n s we r s i n f o r m a t i o n t h e y ga r n e r e d ( o r a l t e r n a t iv e ly f a i l e d t o g a r n e r) a n d r e f l ec t i o n o n t h e in t e r v i e w s P a r t i c u l a r a t t e n t i o n wa s p a i d to a ny t h e m e s w h i c h a r o s e f r o m in t e r v i e w s wh i c h m a y n o t h a v e o r i g i n a l ly b e e n i n c l ud e d i n t h e in t e r v i e w g u i d e a n d t h e s e t h e m e s we r e u s e d to i n f o r m d i s c u ss i o n i n f u t u r e in t e r v i ew s A ll in t e r v i e w s we r e c o n du c t e d i n p e r s o n a t a l o ca t i o n o f t h e p a r t i c i p a n t s p r e f e r e n ce M o s t o f t e n p a r t i c i p a n t s a s k e d to b e in t e r v i ewe d i n t h e i r h o u s e b ut s o m e p a r t i c i p a n t s c h o s e to b e in t e r v i ewe d a t a r e a c o ff e e s h o p s I n t e r v i e w s r a n g e d f r o m 14 mi nu t e s to 59 mi nu t e s T h e a v e r a ge in t e r v i e w wa s a r o u n d 33 mi nu t e s l o n g I n t e r v i e w t im e wa s l a r g e l y d e p e n d e n t o n h o w m u c h t h e p a r t i c i p a n t ca r e d to s h a r e a n d t h e l e n g t h o f t h e in d i v i du a l s b i r t h s t o r y A f t e r my f i r s t in t e r v i ew m y p a r t i c i p a n t a n d a n aca d e mi c a d v i s o r b o t h in d e p e n d e n t l y s u g g e s t e d t h a t I s t a r t my s t u d y by a s k i ng p a r t i c i p a n t s to s h a r e t h e i r b i r t h s to r i e s a n d t h i s m e t h o d wa s u t i l i ze d f r o m t h i s p o in t o n P a r t i c i p a n t s we r e a s k e d to s h a r e a s m u c h o r a s l i tt l e o f t h e i r s t o r y a s t h e y we r e c o m f o r t a b l e w i t h a n d s o m e g a v e v e r y d e t a il e d a n d i n v o lv e d s t o r i e s w h il e o t h e r s p r e s e n t ed s u mm a r i e s T h i s a l l o we d f o r a m u c h m o r e ea s ily f l o w in g n a rr a t iv e a n d a

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33 p l ac e f o r p a r t i c i p a n t s to p r o v i de m u c h g r ea t e r d e t a i l a b o ut t h e i r b i r t h t h a n my f i r s t in t e r v i e w g u i de h a d a l l o we d f o r M u l t i p l e s t e ps we r e t a k e n to s ec u r e t h e p a r t i c i p a n t s a n o nym i t y t o e n s u r e t h a t p a r t i c i p a n ts we r e n o t i d e n t i f i a b l e B e c a u s e p a r t i c i p a n t s d i s cu ss e d in t im a t e a n d s o m e t im e s d i f f i c u l t p a r t s o f t h e i r b i r t h confidentially w a s im p o r t a n t i n o r d e r to p r e v e n t t h e s e e x p e r i e n c e s f r o m b e i ng d i r e c t l y c o nn e c t e d to t h e m e s p e c i a lly t h o s e w h o h a d a t t e n d e d t h e b i r t h h a d k n ow l e dge o f t h e i r b i r t h a n d/ o r m a y h a v e b e e n i n v o lv e d i n a n e g a t iv e in t e r a c t i o n E ac h p a r t i c i p a n t wa s a s k e d to e i t h er c h oo s e a p s e ud o n y m o r a pp r o v e a n a m e w h i c h I h a d c h o s e n f o r t h e m d e p e n d i ng o n t h e i r p r e f e r e n ce N o n a m e s o f b i r t h i ng p r o f e s s i o n a l s p l ace s o f b i r t h o r a ny o t h e r o b v i o u s ly i d e n t i f i e d i n f o r m a t i o n wa s t r a n s c r i b e d. T r a n s c r i b e d in t e r v i e w s we r e c o d e d w i t h t h e p a r t i c i p a n t s s e ud o ny m W i t h I R B a pp r o v a l p a r t i c i p a n t s we r e o f f e r e d b o t h t h e i r a u d i o r ec o r d i n g s a n d t r a n s c r i p t i o n b ut m y c o p i e s o f t r a n s c r i p t i o ns a n d a u d i o r e c o r d in gs we r e k e pt u n d e r l o c k a n d k e y i n a p e r s o n a l s a f e N o o t h e r c o m p e n s a t i o n wa s o ff e r e d f o r p a r t i c i p a t i o n i n t h e s t u d y C o d in g o f t h e f u lly t r a n s c r ib e d in t e r v i ew s t o o k p l a c e a f t e r d a t a we r e c o l l e c t e d f o r each s u b s a m p l e C o d in g wa s u n d e r s t o o d i n t e r m s o f t h e p r o ce s s o f t r a n s f o r mi ng r a w d a t a in t o a s t a n d a r d i z e d f r o m ( B a bb i e 2007:325 ) I n o r d e r to do t h i s t h e m e s we r e e x t r a p o l a t e d f i r s t f r o m t h e o u t o f h o s p i t a l d a t a a n d t h e n f r o m t h e h o s p i t a l d a t a A c o l o r c o d in g s y s t e m wa s u s e d t o c r ea t e a k e y f o r eac h t h e m e a n d d a t a c o d e d u n d e r t h e s a m e t h e m e we r e t h e n e x a m i n e d t o g e t h e r S o m e t h e m e s f r o m ea c h s u b s a m p l e o v e r l a pp e d, w hi l e o t h e r s w h e r e d e v e l o p e d f o r t h e s p e c i f i c s u b s a m p l e T h e m e s w h i c h a p p li e d t o o n e s u b s a m p l e b ut n ot t h e o t h e r a r e l a t e r e x a m i ne d i n t h e a n a l y s i s s ec t i o n F o r

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34 e x a m p l e d i s c u ss i o n s o f e m p o we r m e n t we r e f o u n d i n b o t h s u b s a m p l e s w hi l e rejection of medicalization was only found in the out of hospital sub sample. Re s e a r c h e r P o s i t ions M y o w n p o s i t i o n a s a s t ud e n t r e s ea r c h e r w o m a n o f c hi l d b ea r i ng y ea r s a n d m e m b e r o f t h e n a t u r a l b i r t h i ng c o mm u n i t y s h ou l d b e c o n s i d e r e d i n t h i s r e s ea r c h De s p i t e t h e f ac t t h a t I h ad o n l y m e t t w o o f m y p a r t i c i p a n t s p r e v i o u s l y I f o und b u il d i ng r a pp o r t w i t h m a ny o f m y p a r t i c i p a n t s wa s r e l a t iv e ly e a s y a s g e n e r a l ly t h e y we r e e x t r e m e l y w e l c o mi ng. A s s o m e o n e w h o i s in t e r e s t e d i n h a v i ng c hi l d r e n I m a de t h i s p o s i t i o n k n ow n to m y p a r t i c i p a n t s I b e li e ve t h a t t h i s wa s s o m e t h i ng w h i c h put t h e m a t ea s e w h e n t a l k i n g to m e k n ow in g t h a t n ot o n l y wa s I a r e s ea r c h e r in t e r e s t e d i n t h e i r e x p e r i e n c e f r o m a n a c a d e mi c p e r s pec t iv e b ut a l s o a s a y o u n g w o m a n in t e r e s t e d i n b i r t h i ng f o r m o r e p e r s o n a l r e a s o n s A f t e r eac h in t e r v i e w c o n v e r s a t i o n s n a t u r a l ly o cc u rr e d w i t h m y p a r t i c i p a n t s a n d o f t e n t im e s t h e s e c o nv e r s a t i o ns we r e f o c u s ed a r o u n d m y r e s ea r c h a n d t h e a im s o f t h i s s t u d y T h e s e d i s c u s s i o ns a l s o t e n d e d to f o c us o n t h e p a r t i c i p a n t f u r t h e r e x p l a i n i ng t h e v a l i d i t y o f t h e i r c h o i c e s s e t t in g, a n d ca r e p r o v i d e r T h e s e d i s c u s s i o ns t h o r o ugh l y i n f o r m e d t h e im p o r t a n c e o f p l a c i ng m y p a r t i c i p a n t s a n d my a n a l y s i s o f t h e i r e x p e r i e n c e i n a n o n j ud g m e n t a l li g h t f o c u s i ng o n t h e im p o r t a n c e o f in d i v i du a l c h o i c e a s a p a r a m o u n t o f t h i s r e s ea r c h T h i s f o c us i s m e a n t to h i g hl i g h t t h e b e l i e f t h a t t h e r e i s n o t a b l ack a n d w h i t e r i g h t a n d r o n c h o i ce b ut in s t ea d t h a t t h e in t e r e s t s b e li e f s a n d p e r s o n a l i t y o f a n i n d i v i du a l s m u s t a l l b e t a k e n in t o c o n s i d e r a t i o n w h e n e x a m i n i ng b i r t h c h o i c e s O n e o f my o w n l i f e p o s i t i o ns w h i c h s h ou l d b e m e n t i o n e d i s m y w o r k w i t h i n t h e n a t u r a l b i r t h in g c o mm u n i t y i n t h e a r e a I r e s i d e T h o ugh I h a d p a ss i v e ly b ee n in t e r e s t e d

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35 i n t h i s s ub j e c t f o r h a lf a d eca d e s in c e my o w n v i e w i ng o f t h e f i l m T he B u s in e s s of B e ing B o r n I h a d n ot a c t iv e ly b e g u n t o w o r k i n a ny f a c e t o f t h i s m o v e m e n t u n t i l t h e p a s t f e w m o n t h s O ne o f m y o w n r ea s o ns f o r w o r k i n g w i t h i n t h i s ca u s e s t e m s f r o m a d e s i r e t o s e e m o r e s up p o r t f o r in d i v i du a l c h o i ces w h i c h d e v i a t e f r o m s o c i e t a l n o r m s a n d f e a r s T h e m a j o r i t y o f m y o w n ac t i v i s t v o l u n t ee r a n d p a i d w o r k f o c u s e s o n t h e r e p r o du c t iv e j u s t i c e m o v e m e n t i n a v a r i e t y o f f ace t s a l s o in c l u d i ng acce s s to s e x e du ca t i o n b i r t h c o n t r o l a n d a b o r t i o n ca r e I b e li e v e t h a t a l t h o ugh a t t im e s my w o r k w i t h i n t h e n a t u r a l b i r t h in g c o mm u n i t y m a y c r ea t e a b i a s p a r t i c u l a r ly a s to w h e r e I p l a n t o g iv e b i r t h i n t h e f u t u r e I h a v e b ee n i n f o r m e d by t h e e x p e r i e n c e s w i t h i n t h i s c o mm u n i t y a n d o t h e r c o mm u n i t i e s w i t h i n t h e r e p r o du c t iv e j u s t i c e m o v e m e n t to v a l ue t h e in d i v i du a l w h o r ec e iv e s a ny s o r t o f r e p r o d u c t iv e ca r e a n d t h a t I h a ve w i t n e ss e d a n d e x p e r i e n c e d f i r s t h a n d h o w d e v a s t a t ing j ud g m e n t a l ca r e c a n b e a n d h o w e m p o we r in g n o n j ud g m e n t a l c a r e ca n b e I w o r k e d to r e min d m y s e l f o f t h e s e e x p e r i e n c e s a n d to p o s i t i o n my s e lf i n t h e r o l e o f n o n j ud g m e n t a l r e s e a r che r as m u c h a s p o s s i b l e g i v e n t h e h u m a n p r o p e n s i t y t o w a r ds b i a s

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36 IV ANA L Y S I S AN D D I S CU SS I ON I n b o t h m y h o s p i t a l a n d o u t o f h o s p i t a l s a m p l e s p a r t i c i p a n t s c o n ce p t i o n s o f t h e i r in t e r ac t i o n s a n d e x p e r i e n ce s a s w e ll a s t h e c h o i c e s t h e y m a de i n t h e i r b i r t h a n d h o w t h e y f e l t a b o ut t h e s e c h o i c e s d i d s e e m t o b e i n f l u e n ce d by b i r t h s e t t in g, ca r e p r ac t i t i o n e r a n d b i r t h p l a n. T h e f i r s t s e c t i o n o f t h i s c h a p t e r e x a mi n e s t h e d i ff e r e n t r ea s o n s m y p a r t i c i p a n t s g a v e f o r b i r t h i ng i n t h e i r r e s p ec t iv e s e tt in g s w h i c h p r o v i d e s s o m e i n s i g h t in to w hy a n in d i v i du a l m i g h t b e m o r e l i k e ly t o c h o o s e o n e s e t t in g o v e r a n o t h e r T h e n e x t s ec t i o n d i s c u ss e s f i n d i ngs r e l a t in g t o c o n t r o l a n d h i g h li g h t s t h e w a y s c o n t r o l wa s u n d e r s to o d by p a r t i c i p a n t s i n ea c h s a m p l e in d i v i du a l u n d e r s t a n d i n g s o f p e r s o n a l c o n t r o l i n t h e b i r t h s e tt i n g, a s w e l l a s a tt e m p t in g to u n d e r s t a n d h o w a n d w hy p a r t i c i p a n t s e x p e r i e n ce d a l ac k o f c o n t r o l i n t h e b i r t h s e tt in g. T h e f o l l ow i ng s ec t i o n d i s c u s s e s e m p o we r m e n t a n d f o c u s e s o n h o w p a r t i c i p a n t s e x p e r i e n c e d e m p o we r m e n t i n t h e i r p r e g n a n c i e s a n d b i r t h a n d h o w t h e s e c o n ce p t i o ns o f p e r s o n a l e m p o we r m e n t w e r e s h a p e d by b i r t h s e t t in g, b i r t h p l a n a n d ca r e p r o v i d e r B i r t h S e tt i ng: Re a s ons and C hoi ce s T h e m a i n r ea s o n f o r b i r t h i ng i n t h e h o s p i t a l r e v o l v e d a r o u n d acce s s to m e d i c a l in t e r v e n t i o n T h r e e p a r t i c i p a n t s g a v e b i r t h i n t h e h o s p i t a l f o r m e d i c a lly n e ce ss i t a t e d r ea s o n s F o r t h e p a r t i c i p a n t s w h o g a v e b i r t h i n t h e h o s p i t a l b ec a u s e o f a m e d i c a lly n ec e s s i t a t e d r ea s o n b i r t h w i t h i n t h e h o s p i t a l wa s n o t f r a m e d a s a c h o i c e O ne p a r t i c i p a n t T a b a t h a f o r e x a m p l e e l ec t e d f o r a C s ec t i o n b eca u s e o f h e r m e d i c a l

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37 h i s t o r y a n d g i v i ng b i r t h o u t s i de o f t h e h o s p i t a l wa s s i m p ly n o t a n o p t i o n f o r h e r E x a m p l e s li k e t h e s e h i g hl i g ht n ot o n l y t h e n ec e s s i t y o f t h e h o s p i t a l e nv i r o n m e n t b ut a l s o t h e f a c t t h a t b i r t h s e tt in g i s not a l w a y s s o m e t h i ng w h i c h c a n b e c h o s e n. O nly t h r e e o f m y p a r t i c i p a n t s c h o s e to g iv e b i r t h a t t h e h o s p i t a l a ll t h r o ugh t h e i r p r e gn a n c y f o r n o n m e d i c a lly n e ce ss i t a t e d r ea s o n s e i t h e r b eca u s e o f acc e s s t o p a i n m a n a g e m e n t a f e e l i ng o f s a f e t y o r a f a mily t r a d i t i o n o f b i r t h i ng i n h o s p i t a l T h e h o s p i t a l s a m p l e a l s o c o n t a in e d t w o p a r t i c i p a n t s w h o t r a n s f e rr e d to t h e h o s p i t a l s e t t in g f r o m a n o u t o f h o s p i t a l s e t t in g. F o r t h e s e p a r t i c i p a n t s t r a n s f e r r in g t o t h e h o s p i t a l wa s a mi x o f c h o i c e a n d n ec e s s i t y A l t h o ugh n e i t h e r o f t h e s e p a r t i c i p a n t s s e e m e d to f ac e a ny im m e d i a t e m e d i c a l d a n g e r w h e n t h e y t r a n s f e rr e d, t h e d i f f i c u l t y a n d in t e n s i t y o f t h e i r b i r t h s m a de i t e v i d e n t t h a t t h e y needed to g o to t he h o s p i t a l e nv i r o n m e n t F o r eac h o f t h e s e i n d i v i d u a l s t h e y r ec o u n t e d a p o in t i n t h e i r b i r t h w h e r e t h e i r p a i n a n d e x h a u s t i o n m a de i t e v i d e n t to t h e m t h a t t h e y n e e d e d to g o to t h e h o s p i t a l A l t h o ugh t h e r ea s o n s f o r u t i l i z i ng t h e h o s p i t a l we r e v a r i e d, acce s s t o m e d i c a l in t e r v e n t i o n w a s at t h e h ea r t o f ea c h o f t h e r ea s o n s f o r h a v i ng a h o s p i t a l b i r t h S e l ec t i o n o f t h e o u t o f h o s p i t a l s e t t in g wa s a l w a y s a n ac t iv e c h o i ce B ecau s e o u t o f h o s p i t a l b i r t h i ng i s n o t t h e n o r m o n e can n o t p a s s i v e l y c h oo s e a m i d w i f e a ss i s t e d o u t o f h o s p i t a l l a b o r i n t h e s a m e w a y t h a t o n e mi g h t a n O B / GY N a s s i s t e d h o s p i t a l b i r t h A ll o f my p a r t i c i p a n t s h a d ac t iv e ly p l a nn e d a n o ut o f h o s p i t a l mi d w i f e a s s i s t e d l a b o r P r e v i o us n e g a t iv e o r a m b i v a l e n t e x p e r i e n c e b i r t h in g i n t h e h o s p i t a l w i t n e s s i ng s o m e o n e e l s e s b i r t h or h a v i ng p r e v i o us e x p e r i e n c e w i t h a n O B ea c h c o n t r ib u t e d to c h o o s i ng a n o u t o f h o s p i t a l b i r t h F o r eac h o f t h e s e p a r t i c i p a n t s a n o u t o f h o s p i t a l b i r t h wa s a n a t t e m p t to r ec e iv e a d i ff e r e n t s t yl e o f ca r e a n d a v o i d ce r t a i n

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38 a s p e c t s o f t h e h o s p i t a l s e t t in g. F o ur o f m y p a r t i c i p a n t s we r e c o n v i n ce d o r i n s p i r e d t o h a v e a n o ut o f h o s p i t a l b i r t h b y a f r i e n d o r ac qu a in t a n c e T w o o f t h e s e p a r t i c i p a n t s we r e in d i v i d u a l s w h o h a d m e n t i o n e d p r e v i o u s ly w i t n e s s i ng n e g a t i ve h o s p i t a l e x p e r i e n ce s F o r a l l o f t h e s e p a r t i c i p a n t s w i t n e s s i ng o r d i s c u s s i ng p o s i t iv e o u t o f h o s p i t a l e x p e r i e n c e s e n c o u r a g e d t h e m t o m a ke t h e c h o i c e to b i r t h i n t h e i r h o m e o r a t a b i r t h i n g h o m e a n d p r o v i d e d s o m e h o pe f o r a p o s i t iv e b i r t h i ng e x p e r i e n ce A v o i d a n c e o f t h e h o s p i t a l s e tt in g wa s a n o t h e r p r im a r y r ea s o n p a r t i c i p a n t s c h o s e to g iv e b i r t h o u t s i de o f t h e h o s p i t a l S i x o f m y p a r t i c i p a n t s d i s c u s s e d e i t h e r t h e e nv i r o n m e n t s u c h a s l i g h t s s o u n d s a n d d c o r or t h e ph y s i c a l s e tt in g o f t h e h o s p i t a l s u c h a s s t a t in g t h e y d i s l i k e d t he h o s p i t a l a s o n e o f t h e r ea s o n s t h e y c h o s e to g i ve b i r t h o u t s i de o f t h e h o s p i t a l I n f a c t a l l o f my p a r t i c i p a n t s w h o c h o s e to g iv e b i r t h i n t h e o u t o f h o s p i t a l s e tt in g e x p l i c i t l y s t a t e d t h a t t h e y f e l t m o r e c o m f o r t a b l e i n t h e h o m e s e tt in g. A s i de f r o m a v o i d in g t h e p h y s i c a l e n v i r o n m e n t o f t h e h o s p i t a l p a r t i c i p a n t s i n t h e o u t o f h o s p i t a l s e tt in g a l s o w i s h e d to a v o i d t h e m e d i c a l i ze d a s p e c t s o f t h e h o s p i t a l A ll e i g h t o f t h e o u t o f h o s p i t a l p a r t i c i p a n t s d i s c u s s e d m e d i c a l in t e r v e n t i o n a s s o m e t h in g t h e y w i s h e d to a v o i d, a n d a r ea s o n t h a t b i r t h in g o u t s i de o f t h e h o s p i t a l w a s im p o r t a n t to t h e m C o m m o n t h e m e s in c l ud e d p a r t i c i p a n t s d i s c u s s i ng h o s p i t a l s t a f f in t e r v e n in g o r in t e r f e r in w i t h b i r t h too m u c h H a l f o f t h e p a r t i c i p a n t s m e n t i o n e d C e s a r e a n s ec t i o n as s o m e t h in g t h e y f e l t t h e y h a d a b e t t e r c h a n c e o f a v o i d i ng by b e i ng o u t o f t h e h o s p i t a l T w o o f t he p a r t i c i p a n t s h a d h a d h o s p i t a l b i r t h s b ut we r e l oo k in g f o r s o m e t h i ng m o r e d e s p i t e t h e f ac t t h a t t h e y d i d n o t n ece s s a r i ly ca t e g o r i z e t h e i r h o s p i t a l bi r t h s a s n e g a t iv e A ll o f t h e o u t o f h o s p i t a l p a r t i c i p a n t s e x p r e s s e d o p i n i o ns a b o ut b i r t h w h i c h p o s i t i o n e d i t a s a n a t u r a l a n d n o r m a l e x p e r i e n ce.

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39 A l t h o ugh t h e r e we r e a v a r i e t y o f r ea s o n s w hy ea c h in d i v i du a l c h o s e to g i ve b i r t h i n t h e s e t t in g t h e y d i d, t h e r e we r e s o m e c o n s i s t e n c i e s a m o n g s t t h e t w o s a m p l e s E v e r y i n d i v i d u a l w h o g a v e b i r t h w i t h i n t h e h o s p i t a l d i d s o b eca u s e o f ac c e s s to m e d i c a l in t e r v e n t i o n T h i s m a y h a ve b e e n a c o n s c i ou s c h o i c e to r ec e iv e in t e r v e n t i o n a s wa s t h e ca s e f o r p a r t i c i p a n t M i c h e l l e w h o ac t iv e ly l i k e d e p i d u r a l s ; b eca u s e t h e m e d i c a l in t e r v e n t i o n wa s s ee n a s n e ce s s a r y a s wa s t h e ca se f o r m y p a r t i c i p a n t s w h o we r e r e s t r i c t e d to t h e h o s p i t a l s e tt in g b e ca u s e o f m e d i c a l c o n d i t i o n s ; o r b e c a u s e t h e y r e a l i ze d t h a t t h e y n ee d e d a ce r t a i n t y pe o f in t e r v e n t i o n t h a t wa s n ot o f f e r e d i n a ny o t h e r s e t t in g, a p o s i t i o n i nh a b i t e d by b o t h p a r t i c i p a n t s w h o t r a n s f e rr e d f r o m a n o ut o f h o s p i t a l b i r t h to t h e h o s p i t a l A l t h o ugh b i r t h i ng i n t h e h o s p i t a l m a y n o t a l w a y s h a v e b e e n a c h o i c e t he m a i n r e a s o n f o r b i r t h i ng i n t h e h o s p i t a l f o r a l l o f m y p a r t i c i p a n t s c o n s i s t e n t l y c e n t e r e d o n acce s s to in t e r v e n t i o n. B i r t h i ng o u t s i d e o f t h e h o s p i t a l o n t h e o t h e r h a n d, wa s a l w a y s a c h o i ce a n d o n e w h i c h i n v o l v e d ac t iv e ly r e j ec t in g t h i s m e d i ca l in t e r v e n t i o n B y r e j ec t in g t h e h o s p i t a l s e tt in g, t h e s e p a r t i c i p a n t s we r e a l s o d e n yi ng t h e s t a t us q u o, g o i ng a g a in s t p o pu l a r i d e a l s c o n ce r n i ng accep t a b l e b i r t h in g p r ac t i ce s T h i s p o s i t i o n e d t h e i r c h o i c e t o bi r t h o u t o f t h e h o s p i t a l a s a s u b v e r s i ve c h o i ce, w h i c h i s l a t e r e x e m p l i f i e d by t h e r eac t i o ns t h e s e i n d i v i du a l s f ace d b eca u s e o f t h e i r c h o i ce. U n d e r s t a n d i ng o ut o f h o s p i t a l b i r t h i ng a s a s u b v e r s i ve c h o i c e m a k e s i t s i g n i f i ca n t l y d i f f e r e n t f r o m b i r t h i ng i n t h e h o s p i t a l w h i c h m a y n o t a l w a ys b e a c h o i ce a n d m o s t o f t e n m e e t s s t a n d a r d d e f i n i t i o ns o f w h a t a n o r m a l o r acce p t a b l e b i r t h i s T h e ac t iv e s u b v e r s i ve c h o i c e t h a t o u t o f h o s p i t a l p a r t i c i p a n t s f a ce d m a y h a v e k e y e d t h e s e p a r t i c i p a n t s in to s t r u c t u r a l i ss u e s w i t h i n t h e r e a l m o f b i r t h i ng t h a t w o m e n f a c e i n a w a y t h a t m a y n o t h a v e b e e n e x p e r i e n ce d by

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40 w o m e n w ho we r e g i v in g b i r t h i n t h e h o s p i t a l C on t r o l in t he H o s pi t al S e tt i ng E ac h o f m y p a r t i c i p a n t s i n t h e h o s p i t a l s a m p l e p r ov i d e d s o m e e v i d e n ce e i t h e r e x p li c i t l y o r im p l i c i t l y o f p e r s o n a l c o n t r o l i n t h e i r b i r t h E x pl i c i t e x a m p l e s r e f e r to s i t u a t i o n s i n w h i c h p a r t i c i p a n t s a n s w e r e d qu e s t i o ns d i r ec t l y r e l a t e d to t h e e x p e r i e n c e o f c o n t r o l i n t h e b i r t h i ng e nv i r o n m e n t ( i e a p o s i t iv e a n s we r to t h e q u e s t i o n D i d y o u f e e l li k e y o u h a d a l o t o f c o n t r o l i n y o ur b i r t h e nv i r o n m e n t ? ) o r s i t u a t i o n s i n w h i c h p a r t i c i p a n t s b r o ug h t up t h e i r e x p e r i e n c e w i t h c o n t r o l o n t h e i r o w n ( i e a p a r t i c i p a n t s s t a t in g t h a t t h e y h a d a l o t o f c o n t r o l o v e r w h a t was h a pp e n i ng i n v o l v i ng t h e i r b i r t h in g ca r e ) I m p l i c i t a n s we r s r e f e r to s i t u a t i o n s i n w h i c h t h e w o r d c o n t r o l wa s n o t d i r ec t l y u s e d, b ut i n w h i c h a p a r t i c i p a n t s t i ll i n d i ca t e d a h i g h l e v e l o f c o n t r o l o v e r t h e e v e n t s o f t h e i r b i r t h ( i e a p a r t i c i p a n t t e ll s a l l t h e w a y s t h e y e n f o r ce d t h e i r b i r t h p l a n du r in g l a b o r d e s p i t e t h e f ac t t h a t t h e y d o n ot d i r e c t l y s a y t h e y we r e c o n t r o lli t h e s i t u a t i o n ) A l t h o ugh a l l o f t h e p a r t i c i p a n t s e x p r e ss e d h a v i ng c e r t a i n l e v e l s o f c o n t r o l o v e r t h e i r b i r t h, o n l y t w o o f t h e e i g h t h o s p i t a l b i r t h i ng p a r t i c i p a n t s d i s c u s s e d c o n t r o l o v e r d e c i s i o n m a k i ng a s b e i ng im p o r t a n t to t h e m i n a ny r e a l d e p t h I t i s in t e r e s t in g to n o t e t h a t b o t h o f t h e s e p a r t i c i p a n t s h a d t h e m o s t d e t a il e d b i r t h i ng p l a n s o f t h e h o s p i t a l g r o up, a n d t h e i r f o c us o n c o n t r o l m a y h a ve r e l a t e d to t h e e f f o r t t h e y u n d e r to o k i n p l a nn i ng t h e i r h o s p i t a l b i r t h B o t h o f t h e s e p a r t i c i p a n t s a l s o e x p r e s s e d h a v i ng to a d v o c a t e f o r t h e m s e l v e s h e a vily i n o r d e r to r ece iv e t h e b i r t h t h e y w a n t e d. B o t h o f t h e s e in d i v i du a l s a t t r ib u t e d t h e i r s u cce s s i n c o n t r o l l i ng t h e i r b i r t h to t h e i r p e r s o n a l i t y n o t to t h e e nv i r o n m e n t i n w h i c h t h e y p l a n n e d t h e i r b i r t h o r g a v e b i r t h:

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41 M ia 2 9 H o s p ita l B i r t h: I t h i n k fo r s o m e o n e w h o e it h e r w a s n t a s k n o w l e dg e a b l e o r a s s t r o ng w ill e d as I w a s o r am t h e y w o u l d t h e y c o u l d e a s il y h a v e u h m h a d o t h e r p e o p l e d i c t a t i ng t h ei r b i r t h i n g c h o i ce s uh m b ut b ec a u s e I w a s n o t a f r a i d t o s a y N o o r r e f u s e a m et h o d o f c a r e I w a s I a b l e t o s a y t h at you k n o w I ca n m a ke m y o w n c h o i ce s Ta b a t h a 3 1 H o s p ita l B i r t h: I d e f i n i t e l y ma de e v e r y s i n g l e d ec i s i o n i n m y b i r t h p l a n m y s e l f a n d m a de s u r e i t h a p p e n e d F o r o t h e r s c o n t r o l wa s a c h i e v e d i n w h a t t h e p a r t i c i p a n t s p e r c e iv e d a s t h e i r o w n a bil i t y t o b e ac t iv e p a r t i c i p a n t s i n m a k i ng m e d i ca l d e c i s i o n s t h a t t h e y we r e c o n f l i c t e d a b o ut r ec e i v in g. T h i s wa s a n e s p e c i a lly i m p o r t a n t a s p ec t o f c o n t r o l f o r t h e p a r t i c i p a n t s w h o h a d t r a n s f e rr e d f r o m o u t o f h o s p i t a l b i r t h in g l o ca t i o n a n d t h e p a r t i c i p a n t s w h o h a d h a d u n p l a n n e d C s ec t i o ns ( o n e o f t h e s e t h r e e p a r t i c i p a n t s e x p e r i e n c e d b o t h a t r a n s f e r a n d a n u n p l a nn e d C s ec t i o n ) I n put i n d i s c u s s i o n a b o ut w h a t s t ep s n ee d e d to b e t a k e n wa s a n im p o r t a n t wa y f o r t h e s e pa r t i c i p a n t s to m a in t a i n c o n t r o l a n d a g e n c y e v e n i f t h e y we r e n o t a b l e to a ch i e v e t h e b i r t h t h a t t h e y ha d o r i g i n a lly d e s i r e d. F o r t w o p a r t i c i p a n t s t h e h o s p i t a l e nv i r o n m e n t wa s f r a m e d a s a p l ac e o f c o n t r o l b e c a u s e o f t h e acce s s t o m e d i c a l t ec h n o l og y i t p r o v i d e d. W h i le t hi s acc e s s to m e d i c a l t ec h n o l og y c o u l d b e s im p ly c o n s i d e r e d a r ea s o n f o r c h o o s in g h o s p i t a l b i r t h t h e i r a n s we r s r e v e a l e d m o r e a b o ut t h e i r f e e l i ngs c o n n ec t e d to acce s s to m e d i c a l t ec h n o l og y T h e s e p a r t i c i p a n t s p o s i t i o n e d o u t o f h o s p i t a l b i r t h a s s o m e t h in g d a n g e r o u s w h i c h w ou l d m a ke t h e m f ee l l i ke t h e y d i d n o t h a v e t r u e c o n t r o l o v e r t h e i r b i r t h b eca u s e t h e y w ou l d n o t h a v e a cc e s s to m e d i ca l t ec h n o l og y i f s o m e t h i ng we r e to go w r o n g i n t h e i r

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42 b i r t h: A u b r e y 26, H o s p ita l B i r t h: I m ea n t h e o t h e r t h i n gs a r e c oo l li ke t h e w at e r b i r t h w o u l d b e a w e s o m e b ut a t t h e s a m e t im e m y a n x i et i e s a n d c o n t r o l i ss u e s I w o u l d w a nt e v e r y e v e r y t h i n g t o b e a b l e t o h a pp e n i f s o m e t h i n g w e r e t o go w r o n g A n n e 2 6 H o s p ita l B i r t h: h e r e w a s n e v e r a g u a r a n t e e t h a t e v e r y t h i n g o nna go j u s t a s y o u h o pe i t w i l l U h y o u y ou k n e v e r k n o w i f yo u k n o w i t g o n n a t u rn i n t o a n e m e r g e n c y s it u ati o n a n d yo u r e g o nna w i s h t h a t yo u h a d b ee n a t t h e h o s p it a l B o t h o f t h e s e pa r t i c i p a n t s d i d h a ve c o m p l i ca t i o n s in t h e i r b i r t h w h i c h n e ce ss i t a t e d m e d i ca l in t e r v e n t i o n a n d t h e s e e x p e r i e n ce s s u r e ly h a d a n e ff e c t o n h o w t h e y c o n ce p t u a li ze d t h e s a f e t y o f p r e g n a n c y a n d l a b o r L a c k of C on t r o l in t he Ho s pi t al S e tt i ng E x p r e s s i o ns o f l a c k o f c o n t r o l i n t h e b i r t h s e tt i n g we r e p r e v a l e n t i n t h e h o s p i t a l s a m p l e w h e t h e r i t wa s b e c a u s e o f a p h y s i c a l l ac k o f c o n t r ol due to i n t e r v e n t i o n o r t h e e x e r t i o n o f c o n t r o l o v e r t h e p a r t i c i p a n t by a m e d i c a l p r o f e ss i o n a l A ll e i g h t p a r t i c i p a n t s e x p r e s s e d s o m e a s p ec t o f t h e i r b i r t h o r b i r t h p l a n t h a t t h e y we r e o u t o f c o n t r o l o f a t s o m e p o in t du r in g t h e i r p r e g n a n c y o r l a b o r O n l y o n e p a r t i c i p a n t d i d n o t e x p r e s s r e s t r i c t i o n o f h e r c o n t r o l o f h e r b i r t h i ng e nv i r o n m e n t o n t h e d a y o f h e r ac t u a l l a b o r T h e r e wa s a l s o o n e p a r t i c i p a n t w h o e x p li c i t ly s t a t e d t h a t s h e wa s n o t to t a l ly i n c o n t r o l b ut t h a t s h e wa s n ot up s e t a b o u t i t b eca u s e s h e li k e d to g o w i t h t h e f l o w F o ur o f t h e p a r t i c i p a n t s e x p r e s s e d a n i n s t a n c e du r in g t h e i r b i r t h i n w h i c h a m e d i c a l p r o f e s s i o n a l

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43 a tt e m p t e d o r s u cce s s f u lly e x e r t e d c o n t r o l o v e r t h e i r d e c i s i o n m a k i ng. T w o p a r t i c i p a n t s i n t h i s s i t u a t i o n e x p r e s s e d a l ac k o f c o n t r o l wa s i n t h e f o r m o f a m e d i c a l p r o f e ss i o n a l p r e ss u r in g f o r a n u n w a n t e d m e d i c a l in t e r v e n t i o n s u c h a s a n e p i s i o t o m y o r a r t i f i c i a l b r ea k i ng o f t h e wa t e r s O n e p a r t i c i p a n t d i s c u s s e d n o t b e in g a l l o we d to e a t f oo d i n t h e h o s p i t a l a l t h o ugh s he wa s h u n g r y a n d a n o t h e r d i s c u s s e d a g e n e r a l f e e l i n g o f l ac k o f a u t h o r i t y w i t h i n h e r b i r t h I t m u s t b e n o t e d t h a t t w o o f t h e p a r t i c i p a n t s w h o f e l t a l a c k o f c o n t r o l i n t h e i r b i r t h we r e t r a n s f e r s f r o m a p l a n n e d o ut o f h o s p i t a l b i r t h s o t h e y m a y h a v e a l r ea d y h a d n e g a t iv e c o n ce p t i o n s a b o ut r e s t r i c t i o n s t o t h e i r c o n t r o l b e f o r e e n t e r in g t h e h o s p i t a l s e tt in g, a n d we r e a l s o a l r ea d y f ac in g a c h a n g e i n t h e i r b i r t h w h i c h t h e y m a y h a ve v i e w e d n e g a t iv e l y F i ve p a r t i c i p a n t s d i s c u s s e d l ac k i ng c o n t r o l o v e r t h e i r b od y i n l a r ge p a r t b eca u s e o f u s e o f e p i du r a l s F o ur o f t h e s e p a r t i c i p a n t s d i s c u s s e d b e i ng g i v e n a p a i n k i ll i ng d r ug t h a t p u t t h e m o ut o f c o n t r o l o f t h e i r b od y T h e s e d i s c u ss i o n s r a n g e d f r o m s t a t in g t h a t t h e y s i m p ly c ou l d n t f e e l t h e i r b od y to s t a t in g t h a t t h e y we r e ph y s i ca l ly c o n f i n e d o r o u t o f c o n t r o l o f t h e i r m u s c l e s b e c a u s e o f t h e d r ug. T h e s e d i s c u s s i o ns d i d n ot m e a n h o we v e r t h a t t h e pa r t i c i p a n t wa s un h a p p y a b o ut t h e p a i n m a n a g e m e n t t h a t t h e y r ec e i v e d i n f ac t o n l y o n e o f t h e s e p a r t i c i p a n t s e x p r e s s ed n e g a t iv e s e n t im e n t s a b o ut t h e i r p a i n m a n a g e m e n t w h e n a s k e d d i r ec t l y a n d t h e i r c o n ce r n s we r e r e l a t e d to t h e p o s s i b l e e ff e c t t h a t a n e p i du r a l c ou l d h a v e h a d o n t h e i r l a b o r t im e a n d c h il d. U s u a lly t h e s e d i s cu ss i o n s s i m p ly r ec o gn i ze d t h e f a c t t h a t t h e e p i du r a l c h a n g e d t h e p a r t i c i p a n t s r e l a t i o n s h i p to t h e i r b od y i n a w a y t h a t n o t a b l y a ff ec t e d t h e i r ph y s i ca l a bil i t y d e s p i t e t h e f a c t t h at t h e y d e s i r e d a n d b e n e f i t e d f r o m t h e p a i n m a n a g e m e n t H o we v e r t h e r e we r e o t h e r r ea s o n s a n in d i v i du a l c o u l d f e e l o ut o f c o n t r o l o v e r

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44 t h e i r b od y T w o o f m y h o s p i t a l p a r t i c i p a n t s d i s c u s s e d f e e l i ng ph y s i ca l ly o ut o f c o n t r o l o f t h e p r o ce s s o f b i r t h O n e p a r t i c i p a n t C h a r l o t t e h a d a b i r t h i ng h o m e to h o s p i t a l b i r t h t r a n s f e r a n d d e s c r i b ed f e e l i ng to t a l ly o u t o f c o n t r o l du r in g h e r b i r t h C h a r l o tt e s t r ugg l e d w i t h p a i n m a n a g e m e n t a n d r e l a y e d f ee li n g s o f g u i l t a b o ut h o w s h e h a d p r e v i o u s l y b e e n t oo j ud g m e n t a l a b o ut w o m e n w h o h a d g i v e n b i r t h A n o t h e r p a r t i c i p a n t A n n e h a d s e r i o us m e d i c a l c o m p li c a t i o n s du r in g h er p r e g n a n c y w h i c h l e f t h e r b e d r i dd e n o v e r a p e r i o d o f m o n t h s a n d a l s o n ec e s s i t a t e d a s c h e d u l ed ea r l y C s ec t i o n A n n e s s t r ug g l e w i t h t h e s e r i o us c o m p l i ca t i o n s o f h e r p r e g n a n c y l e f t h e r f e e l i ng o u t o f c o n t r o l o f h e r p r e g n a n c y s p e c i f i c a lly w i t h f ea r s t h a t s h e w ou l d mi s c a r r y C on t r o l in t he Ou t o f Ho s pi t al S e tt ing F o r m y o u t o f h o s p i t a l p a r t i c i p a n t s m a ny d i s c u s s i o n s o f c o n t r o l f o c u s e d o n p a r t i c i p a n t s a bil i t y t o m ak e d e c i s i o n s r e l a t e d to t h e i r b i r t h O ne a s p ec t o f c o n t r o l t h a t t h e p a r t i c i p a n t s e m p h a s i ze d t h e im p o r t a n c e o f b e i ng a b l e t o c h o o s e b e t wee n d i f f e r e n t t r e a t m e n t o p t i o n s s o m e t h in g w h i c h o f t e n n o t e d a s b e in g e s p e c i a lly p r e v a l e n t i n t h e h o m e b i r t h s e tt in g. T h i s quo t e from f i r s t t im e m o t h e r A m a n d a i n r e s p o n s e t o b e in g a s k e d h o w m u c h c o n t r o l s h e h a d o v e r h e r b i r t h s e t t in g, h i g hl i g h t s s o m e o f t h e t y p i ca l e x a m p l e s w h e r e d e c i s i o n m a k i ng wa s c i t e d a s b e in g i m p o r t a n t to m y p a r t i c i p a n t s : Amanda, 31, Homebirth I k n o w t h a t w h at e v e r w a s i n G o h a n ds a n d t h e b a b y s h a n d s t h a t w a s t o t h em b ut e v e r y t h i n g e l s e, e v e r y o t h e r f a c t o r w a s m y d ec i s i o n W h e r e d i d I w a nt t o put t h e b i r t h i ng p oo l ? W h o d i d I w a n t t o h a v e t h e r e y o u k n o w ? W h a t k i nd o f m u s i c d i d I w a n t t o p la y yo u k n o w ? W a s I h u n g r y o r n o t ? W a s I t h i r s t y yo u k n o w ? W h a t do I w a nt t o d o ? D o I w a n t t o

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45 c h ec k m y d i l ati o n o r n o t ? D o I w a n t t o g e t o ut o f t h e b i r t h i n g t u b ? I m ea n I c o u l d h a v e j u s t s ta y e d t h e r e u n ti l t h e b a by w a s b o r n. E v e r y t h i n g w a s m y d ec i s i o n T h i s quo t e h i g hl i g h t s h o w d e c i s i o n m a k i ng du r i ng b i r t h wa s a n im p o r t a n t wa y f o r w o m e n i n t h i s s t u d y to e x e r t c o n t r o l o v e r t h e i r b i r t h d e s p i t e t h e f ac t t h a t t h e y m a y n o t b e i n c o n t r o l o f t he i n v o l u n t a r y p r o ce ss e s o f l a b o r A m a n d a s statement a l s o t o u c h e s o n a n o t h e r im p o r t an t a s p ec t o f c o n t r o l i n t h e o u t o f h o s p i t a l b i r t h s p a ce : c o n t r o l o v e r w h o wa s p r e s e n t a t t h e b i r t h W hi l e a l l o f my p a r t i c i p a n t s h ad s o m e l e v e l o f c o n t r o l o v e r w h o wa s g o in g to a t t e n d t h e i r b i r t h t h o s e w h o we r e b i r t h i ng i n t he h o m e e nv i r o n m e n t we r e f r e e to i nv i t e a s m a ny o r a s f e w in d i v i du a l s t o t h e i r b i r t h a s t h e y w a n t e d, a n d h a d l e s s ca r e p r o v i d e r s w h o t h e y h a d n o t m e t p r e s e n t D i s c u ss i o n s o f c o n t r o l o v e r w h o was c o mi ng to t h e b i r t h we r e b r o ug h t up a s a t o p i c o f c o nv e r s a t i o n by f i ve p a r t i c i p a n t s A n o t h e r a s p ec t o f c o n t r o l o v e r w h o wa s a b l e to a t t e n d t h e b i r t h wa s a bil i t y t o h a v e f a mil y p a r t i c u l a r ly y ou n g c h il d r e n p r e s e n t du r in g l a b o r a n d d e li v e r y F o ur o u t o f t h e f i ve p a r t i c i p a n t s m e n t i o n e d t he i m p o r t a n c e o f t h e i r c hi l d r e n o r s t e p c hi l d r e n i n t h e ir b i r t h w i t h t w o o f t h e p a r t i c i p a n t s m e n t i o n i ng t h a t t h i s l e v e l o f p a r t i c i p a t i o n m a y n o t h a v e b e e n po s s i b l e f o r t h e i r c hi l d r e n i n t h e h o s p i t a l s e t t in g. F o r o t h e r pa r t i c i p a n t s c o n t r o l o v e r w h o c a m e to t h e b i r t h wa s m o s t im p o r t a n t i n w ho t h e y e x c l ude f r o m t h e i r b i r t h A l t h o ugh t h e e x c l u s i o n o f i n d i v i du a l s f r o m o n e s b i r t h m a y n o t be e x c l u s i v e ly a n o ut o f h o s p i t a l ph e n o m e n o n i t i s i n t e r e s t in g t h a t eac h o f t h e s e p a r t i c i p a n t s e x c l ud e d s o m e o ne o n t h e b a s i s o f t h e in d i v i du a l b e i ng n e g a t iv e a b o ut t h e b i r t h s e tt in g o r wa y i n w h i c h t h e p a r t i c i p a n t wa s g i v i ng b i r t h a n d e x p e r i e n c e

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46 w h i c h wa s u n i que to t h e o u t o f h o s p i t a l s a m p l e F o r t h e s e p a r t i c i p a n t s c o n t r o l c a m e i n t h e f o r m o f a v o i d i ng n e g a t i v i t y a nd u n s upp o r t iv e n e s s i n t h e i r c h o s e n b i r t h s e tt in g by d i r ec t l y r e m o v i ng in d i v i du a l s I t i s i m p o r t a n t to n o t e t h a t w h il e s o m e p a r t i c i p a n t s f e l t v e r y s t r o n g l y a b o ut c o n t r o l l i ng w h o t h e y k n e w a n d w h o t h e y d i d n o t k n o w a s f a r a s s t a f f p r e s e n t f r o m t h e b i r t h i ng h o m e o t h er p a r t i c i p a n t s d i d n o t. T hi s f i n d i ng h i g hl i g h t s t h e i mp o r t a n c e o f u n d e r s t a n d i ng d i f f e r e n t in d i v i du a l p r e f e r e n ce s i n c o n s t r u c t in g a c o m f o r t a b l e b i r t h e nv i r o n m e n t by s h ow in g t h a t w h il e p r e f e r e n ce f o r c o n t r o lli ng w h o a t t e n d e d a b i r t h wa s m o r e p r e v a l e n t i t t h e o u t o f h o s p i t a l s e tt i n g, i t wa s n o t un i v e r s a l w i t h i n my s a m p l e O f t h e f o ur p a r t i c i p a n t s w h o we r e a s k e d h o w t h e y f e l t h a v i ng a m e m b e r o f t h e b i r t h in g h o m e s t a f f p r e s e n t w h o t h e y h a d n o t m e t b e f o r e o n l y o n e e x p r e s s e d a ny d i s c o m f o r t a b o u t t h e e x p e r i e n ce w hi l e t h e o t h e r t h r e e e x p r e s s e d p o s i t iv e s e n t im e n t s d i r ec t ed m o s t l y t o wa r ds t h e n o t i o n o f t a k in g w h a t e v e r h e t h e y c o u l d g e t L a c k of C on t r o l in t he Ou t o f Ho s pi t al Sa m p l e L ac k o f c o n t r o l i n t h e o u t o f h o s p i t a l b i r t h s e tt i n g wa s m o s t l y d i s c u ss e d r e l a t e d to t h e i n v o l u n t a r y a s p ec t s o f t h e b i r t h ing e x p e r i e n ce i n p a r t i c u l a r t h e p a i n a n d d i f f i c u l t y t h a t m a y be r e l a t e d to l a b o r T h e t w o p a r t i c i p a n t s w h o s t a t e d t h a t t h e y d i d n ot f e e l i n c o n t r o l o f t h e i r b i r th d i s c u s s e d t h e ph y s i c a l n a t u r e o f l a b o r n ot o t h e r a s p ec t s o f c o n t r o l s u c h a s d e c i s i o n m a k i ng a bil i t y O n e p a r t i c i p a n t d i s c u ss e d n o t b e in g a b l e to c o n t r o l h e r b od y a n d o n e d i s c u ss e d n o t t h in k i ng a b o ut i t b eca u s e s h e w a s s o i n t h e z o n e T h e s e d i s c u ss i o n s h i g h li g h t t h e d i ff e r e n t w a y s o f u n d e r s t a n d i n g c o n t r o l a s i t r e l a t e s to t h e b i r t h s e tt in g. E v e n i f p a r t i c i p a n t s f e l t

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47 e n t i r e l y i n c o n t r o l o f t h e d e c i s i o n m a k i ng a s p ec t s o f t h e i r b i r t h t h e ph y s i ca l e x p e r i e n c e o f l a b o r c o u l d s t i ll ca u s e t h e m to e x p e r i e n c e a l ac k o f c o n t r o l T h e r e we r e t w o s i t u a t i o ns i n w h i c h p a r t i c i p a n t s d i s c u ss e d b e i ng o u t o f t h e c o n t r o l o f t he d e c i s i o n m a k i ng. J e ss i c a s h ea r t r a t e d r o pp e d, a n d h e r mi d w i f e t o l d h e r to li e d o w n b eca u s e o f t h i s S a r a h h in t e d to a m e m b e r o f h e r b i r t h i ng t e a m t h a t s h e wa n t e d t h e u m bil i c a l c o r d c u t b ut t h e y i n s i s t e d o n d e l a y e d c o r d c l a m p i ng. N e i t h e r o f t h e s e p a r t i c i p a n t s d i s c u s s e d t h e s e s i t u a t i o ns n e g a t iv e l y However, these situations are of in t e r e s t b e ca u s e t h e y h i g h li g h t t h e f ac t t h a t t h e r e a r e ce r t a i n s i t u a t i o ns i n t h e o u t o f h o s p i t a l s e tt in g w h i c h s up e r s e de t h e e m p h a s i s o n p a t i e n t c o n t r o l B o t h o f t h e s e s i t u a t i o ns i n v o lv e d h e a l t h c o n ce r n s : t h e d a n g e r o f a d r o pp in g h ea r t r a t e a n d t h e b e li e f t h a t d e l a y e d c o r d c l a m p i ng w i ll g i ve t h e b a by n ee d e d n u t r i e n t s H o we v e r t h e r e i s s o m e d i ff e r e n c e i n t h e w a y s t h i s l o s s o f c o n t r o l f u n c t i o n e d i n t h e o u t o f h o s p i t a l s a m p l e T h e p a r t i c i p a n t s i n t h i s s u b s a m p l e d i s c u s s e d ac t iv e ly p a r t i c i p a t in g i n t h e d e c i s i o n m a k i ng, a n d h a v i ng a go o d dea l o f c o n t r o l b e f o r e t h e s e l a p s e s C o m p a r i s on of C on t r o l f o r E a c h Sub Sa m p l e T h e p e r c e i v e d im p o r t a n c e o f c o n t r o l v a r i e d ac r o s s t h e t w o s u b s a m p l e s T h e h o s p i t a l s a m p l e s h o we d s o m e d i s t i n c t wa y s t h e b od y b e in g p l ace d o u t o f c o n t r o l ( e g. t h r o ugh e p i du r a l u s a g e ) m a y n ot b e i nh e r e n t l y n e g a t iv e w hi l e t h e ou t o f h o s p i t a l h i g h li g h t e d t h e f ac t t h a t c o n t r o l o v e r d e c i s i o n m a k i ng m a y be o f c e n t r a l i m p o r t a n c e to some in d i v i d u a l s w h e n b i r t h i ng. T h e r e d i d s e e m t o b e m o r e in t e r f e r e n c e w i t h p e r s o n a l c o n t r o l i n t h e h o s p i t a l s e tt in g a s p a r t i c i p a n t s e x p l i c i t ly n o t e d f e e l i ng p r e ss u r e to r ec e iv e m e d i c a l in t e r v e n t i o n t h a t t h e y d i d n o t wa n t W h il e t h e r e we r e a l s o t w o ca s e s o f p a r t i c i p a n t s b e in g o ut o f c o n t r o l o f d e c i s i o n m a k i ng i n t h e o ut o f h o s p i t a l b i r t h s e tt in g,

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48 n e i t h e r o f t h e s e p a r t i c i p a n t s r ec o u n t e d t h i s e x p e r i e n c e a s n e g a t iv e a n d n e i t h e r s t a t e d t h a t t h e y f e l t p r e ss u r e d, a s wa s t h e ca s e f o r m y h o s p i t a l s a m p l e. T h e r e we r e s o m e d i f f e r e n c e s b e t we e n s u b s a m p l e s i n t h e w a y t h a t c o n t r o l w a s d i s c u s s ed i n in t e r v i e w s A l t h o ugh m a ny o f my h o s p i t a l p a r t i c i p a n t s d i s c u s s e d b e in g i n c o n t r o l o f t h e i r b i r t h t h e r e wa s i n g e n e r a l n ot a s m u c h t im e s p e n t d e t a i l i ng t h i s c o n t r o l o r t h e m e a n i ng b e h i nd i t O nly t w o o f m y p a r t i c i p a n t s i n t h e h o s p i t a l s a m p l e d i s c u s s e d t h e i r f e e l i ngs o f c o n t r o l i n a n in d e p t h m a n n e r w h il e a ll b ut o n e o f m y o u t o f h o s p i t a l p a r t i c i p a n t s d i s c u s s e d t h e im p o r t a n c e o f t h e i r c o n t r o l i n a n in d e p t h m a nn e r T h ese in depth discussions h i g hl i g h t a d i ff e r e n c e i n t h e w a y s p a r t i c i p a n t s f r o m ea c h s u b s a m p l e v a l u e d c o n t r o l o v e r d e c i s i o n m a k i ng. P a r t i c i p a n t s w h o we r e r e j ec t i n g t h e h o s p i t a l e nv i r o n m e n t h a d p e r s o n a l j u s t i f i c a t i o n f o r d o in g s o a n d m a y h a v e b e e n p a r t i c u l a r ly in t e r e s t e d i n t h e i r a b i l i t y to c o n t r o l b i r t h i n a w a y t h a t h o s p i t a l p a r t i c i p a n t s we r e n o t. P a r t i c i p a n t s w h o k n e w t h e y we r e b i r t h i ng a t t h e h o s p i t a l m a y a l s o h a v e b e e n m o r e c o m f o r t a b l e w i t h r e li nq u i s h i ng s o m e o f t h e i r c o n t r o l t o a n a u t h o r i t y f i gu r e a n d t h e i r p r e f e r e n c e f o r m e d i ca l in t e r v e n t i o n m a y h a v e m e a n t m o r e t r u s t i n t h e i r do c t o r s a b i l i t y to m a ke d e c i s i o ns f o r t h e m T h i s trust i s r e f l e c t e d i n p a r t i c i p a n t M i c h e ll e s d i s c u ss i o n o f g o in g w i t h t h e f l o w a n d a l s o i n t h e p r e f e r e n ce f o r m e d i c a l in t e r v e n t i o n f o u n d i n in t e r v i ew s w i t h o v e r h a l f o f my h o s p i t a l p a r t i c i p a n t s The group of participants who had to transfer from the out of hospital setting to the hospital setting also provide evi dence of differences in value of control over decision making between people who prefer the hospital setting and those who prefer the out of hospital setting. Two of the participants had transferred during labor, while another participant had to transfer t o hospital care early in her third trimester. Each of

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49 place where they had to work harder to have their voice heard. These participants comprised three of the four parti cipants who expressed feelings of having control exerted over them during their birth. This may highlight differences in the importance and perception of control, which may make hospital birthing harder for those who would have preferred an out of hospital birth. O n e d i f f e r e n c e b e t wee n s u b s a m p l e s w h i c h h i g hlig h t s v a r i a t i o n s i n h o w p a r t i c i p a n t s f r o m ea c h g r o up w o u l d e x p e r i e n c e a d i f f e r e n t s e t t in g i s t h e p r e f e r e n c e f o r u s e o f p a i n r e li e v i ng d r ugs du r in g l a b o r A l l o f m y p a r t i c i p a n t s i n t h e h o s p i t a l s a m p l e r ec e iv e d s o m e f o r m o f s p i n a lly a d mi n i s t e r e d p a i n r e li e f w h i c h r e li e v e d p a in b ut a l s o put t h e b od y s o m e w h a t o u t o f c o n t r o l I n g e n e r a l t h i s lack of control wa s d i s c u ss e d a s a p o s i t iv e o r n e u t r a l by p a r t i c i p a n t s w i t h o n l y o ne p a r t i c i p a n t s t a t in g t h a t t h e y w i s h e d t h a t t h e y h a d n o t r ece iv e d t h e e p i du r a l A l t h o ugh t h e e p i du r a l m a y h a ve ph y s i ca l ly put t h e w o m e n o u t o f c o n t r o l o f s o m e of t h e m o v e m e n t o f t h e i r b od y epidural were a n a s p ec t o f t h e h o s p i t a l e nv i r o n m e n t w h i c h w a s g e n e r a l ly w e ll li k e d. M y o u t o f h o s p i t a l p a r t i c i p a n t s h o we v e r e x p r e ss e d m u l t i p l e r e j ec t i o ns o f t h i s k i nd o f in t e r v e n t i o n w i t h n u m e r o us p a r t i c i p a n t s i n t h e s a m p l e d i s c u s s i ng a d i s c o m f o r t w i t h e p i du r a l s a n d o n l y o n e p a r t i c i p a n t s t a t in g t h a t t h e y w i s h e d t h e y h a d h a d a ny k i nd o f d r ug du r i ng t h e i r l a b o r T h i s c o m p a r i s o n a l s o h i g hl i g h t s t h e d i r ec t r e j ec t i o n o f p a i n r e l i e v i ng in t e r v e n t i o n i n t h e o u t o f h o s p i t a l s e tt in g, a n d t he l i nk a ge b e t wee n h o s p i t a l b i r t h i ng a n d d e s i r e f o r acce s s t o m e d i ca l in t e r v e n t i o n

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50 Empowerment in the Hospital Samp le Another focus of this study was empowerment, or feelings of personal power that the women in this study experienced during labor. Direct discussions of empowerment were one way of attempting to measure participant empowerment during pregnancy and birth Explicit discussed included affirmative answers to question like d i d y o u f e e l l i ke y o u h a d a l o t o f p o we r ? a s w e l l a s u n p r o m p t e d d i s c u s s i o n s o f empowerment a n d p e r s o n a l a b i l i t y a n d e x p r e s s i o n o f f ee li n g s o f p r i de r e l a t e d to o n e s a b i l i t y I f ou n d s o m e e v i d e n c e o f im p l i c i t d i s c u ss i o n s o f e mp o we r m e n t i n my h o s p i t a l s a m p l e f or e x a m p l e a p a r t i c i p a n t w h o we n t t h r o ugh a v e r y d i ff i c u l t b i r t h a n d t a l k e d p o s i t iv e ly a b o u t t he e x p e r i e n c e a n d h e r p e r s o n a l ca p a bil i t y b ut d i d n o t b r i ng up e m p o we r m e n t E x p li c i t e x p r e ss i o n s o f e m p o we r m e n t r e l a t e d to b i r t h we r e e x p r e ss e d by s e v e n o f t h e e i g h t h o s p i t a l p a r t i c i p a n t s a l l i n r e s p o n s e t o qu e s t i o n s w h i c h d i r e c t l y r e l a t e d to e m p o we r m e n t T h e e i g h t h p a r t i c i p a n t s t a t e d t h a t s h e d i d n o t k n o w w h e t h e r o r n ot s h e f e l t e m p o w e r e d s im p ly b e c a u s e s h e h a d n e v e r t h o ug h t a b o u t i t b e f o r e De s p i t e t h i s lack of discussion t hi s p a r t i c i p a n t g a v e m a ny e x p r e ss i o n s o f h e r b e l i e f i n t h e ca p a bil i t y o f h e r s e lf i n h e r b i r t h a n d s e l f a d v o ca c y T h i s discussion of capability m a y i n d i ca t e s o m e l e v e l o f e m p o we r m e n t e v e n i f i t h a d n ot b ee n c o n s c i o u s ly r e a l i ze d. D i s c u s s i o n o f e m p o we r m e n t r e l a t e d to a b i l i t y o f b od y w i t h h a lf o f t h e p a r t i c i p a n t s d i s c u ss i ng e m p o we r m e n t i n t h e s e t e r m s H a l f o f t h e s e p a r t i c i p a n t s d e a l t w i t h w h a t c o u l d b e ca t e g o r i ze d a s v e r y d i f f i c u l t b i r t h s a n d p r e g n a n c i e s a n d t h e ca p a b i l i t y o f t h e i r b od y i n d i f f e r e n t a s p ec t s o f t h e i r b i r t h g a ve t h e m a s e n s e o f e m p o we r m e n t T h e d i f f i c u l t y o f t he s i t u a t i o n wa s f r a m e d a s a n e x t r a o b s t a c l e t h e y o v e r c a m e T h e o t h e r d i s c u ss i o n s o f e m p o we r m e n t we r e l e s s d e s c r i p t iv e b ut a l s o s e e m e d t o c o nn e c t to t h e e m p o we r m e n t

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51 w h i c h s t e m s f r o m t h e ac t o f g i v i ng b i r t h i n g e n e r a l N o n e o f t he p a r t i c i p a n t s d i s c u ss e d t h e h o s p i t a l e nv i r o n m e n t o r h o s p i t a l b i r t h a s i nh e r e n t l y e m p o we r in g. Self r e l i a n c e w a s a n i m p o r t a n t p a r t o f e m p o we r m e n t f o r t w o o f m y h o s p i t a l p a r t i c i p a n t s O n e p a r t i c i p a n t e x p r e ss e d e m p o we r m e n t b eca u s e o f h e r in d i v i du a l a bil i t y t o a d v o ca t e f o r h e r s e l f : M ia 2 9 H o s p ita l B i r t h, In r e s pon s e t o t he q u e s ti o n o y o u fe e l l i k e y ou w e r e u lti m a t e l y e m po w e r e d by y our b i r t : I w o u l d s a y i n m y s it u a ti o n y e s I d o n t h i n k I d o n t h i n k h o s p i t a l b i r t h s a r e necessarily e m po w e r i n g, p e r s e b ut I t h i n k fo r m e u h m I m I f e l t l i ke I m a de m o s t o f t h e d ec i s i o n s fo r m y b i r t h, s o y e s F o r M i a t h e ab il i t y t o s u cce s s f u lly e x e r t c o n t r o l wa s a w a y t o ac h i e ve e m p o we r m e n t A n o t h er p a r t i c i p a n t f i r s t t im e m o t h e r A u b r e y r e j ec t e d t h e i d e a t h a t s uppo r t a i d e d i n h e r e m p o we r m e n t : A u b r e y 26, H o s p ita l B i r t h I d o n t t h i n k t h a t a n y t h i n g t h a t t h a t t h e y c o u l d do w o u l d n ece ss a r il y e it h e r r i s e m e up h i g h e r o r b r i ng m e d o w n l o w e r b ec a u s e I f e l t s o g oo d a bo ut m y s e l f A u b r e y s f ee li n g s a b o ut t h e ca p a bil i t y o f h e r b od y we r e n o t c o nn e c t e d to o u t s i d e r s a n d a l t h o ugh s he d i d h a v e a g r ea t d e a l o f s upp o r t i n h e r b i r t h s he t r ace d h e r e m p o we r m e n t b ac k to h e r o w n a bil i t y and strength during birth D i s e m po w e r m e nt in t he Ho s p i t al Sa m p l e P a r t i c i p a n t s i n t h e h o s p i t a l s a m p l e f ace d l i t t l e n e g a t iv e r eac t i o n to t h e i r b i r t h s e tt in g o r b i r t h p l a n a n d d i d n o t s e e m t o b e a t r i s k f o r t h i s k in d o f d i s e m p o we r m e n t

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52 O n l y t w o p a r t i c i p a n t s d i s c u s s e d f a c i ng a n y n e g a t i ve r eac t i o n s t o t h e w a y o r s e t t i n g i n w h i c h t h e y c h o s e to g iv e b i r t h O n e p a r t i c i p a n t h a d f r i e n d s w h o g a v e b i r t h n a t u r a l l y a n d s a i d t h a t a l t h o ugh t h e y d i d n ot s a y a n y t h i ng d i r ec t l y t o h e r s h e c o u l d f ee l a t t im e s t h a t t h e y we r e j ud g i n g h e r T h ese feelings of negativity are n o t a b l e b eca u s e t h i s p a r t i c i p a n t n ea r l y c o nv i n ce d h e r s e l f to h a v e a n o u t o f h o s p i t a l b i r t h e v e n t h o ugh t h a t wa s n ot w h a t s h e w a n t e d. A n o t h e r p a r t i c i p a n t w h o g a v e b i r t h v i a p l a n n e d C s e c t i o n s t a t e d t h a t s h e f ace d n e g a t iv e r eac t i o n f r o m o t h e r s u n t i l s h e qu a l i f i e d h e r d e c i s i o n w i t h i n a m e d i c a l c o n t e x t B eca u s e o f t h e li m i t e d n a t u r e o f n e g a t iv e r eac t i o n s f ace d, t h ese negative reactions were n o t f o u n d to b e a s o u r c e o f d i s e m p o we r m e n t f o r t h i s s u b s a m p l e T w o p a r t i c i p a n t s d i s c u ss e d d i s e m p o we r m e n t i n t h e f o r m o f t h e f u n c t i o n i ng o f t h e i r b od y De s p i t e t h e f ac t t h a t s h e wa s a b l e t o s u cce s s f u lly b i r t h v a g i n a ll y f i r s t t im e m o t h e r A li c e s t a t ed t h a t s h e b e l i e v e d h e r b od y wa s t o o s m a ll f o r h e r c hi l d du r in g b i r t h He r s u cce s s i n v a g i n a l d e li v e r y d i d n o t s e e m to t r a n s l a t e in t o a s e n s e o f e m p o we r m e n t i n v o l v i ng h e r ph y s i c a l ca p a b i l i t i e s A n o t h e r p a r t i c i p a n t N in a who transferred from the out of hospital setting to the hospital in b oth of her births wa s h o p in g t o ac h i e v e a V B A C ( v a g i n a l b i r t h a f t e r C s ec t i o n ) De s p i t e t h i s d e s i r e, N in a wa s t r a n s f e rr e d a g a in a n d h a d to h a v e a s ec o n d C s ec t i o n N in a h a d t h i s to s a y a b o ut t h e m o m e n t w h e n s h e r e a li ze d s he h a d t o t r a n s f e r to t h e h o s p i t a l : N i n a 2 5, H o s p ital h e f i r s t t im e I f e l t li ke I w a s a v i c t i m b ut t h i s t im e s i n c e i t w a s o n m e I f e lt m o r e l i ke I w a s a f ail u r e N in a s s t a t e m e n t s h i g hl i g h t t h e w a y s u n p l a n n e d or u n d e s i r e d o u t c o m e s i n b i r t h c a n h a ve a s e r i o us im p ac t o n t h e m o t h e r s s a t i s f ac t i o n w i t h h e r s e l f a n d h e r b i r t h

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53 e x p e r i e nce. E m po w e r m e nt in t he Ou t o f Ho s pi t al Sa m p l e F o r m y o u t o f h o s p i t a l s a m p l e s e v e n o f t h e e i g h t w o m e n s t a t e d e x p li c i t ly t h a t t h e y f e l t e m p o we r e d by t h e i r b i r t h T h e o t h e r p a r t i c i p a n t wa s n o t a s k e d a b o ut h e r e x p e r i e n ce s o f e m p o we r m e n t a n d d i d n o t g iv e a ny e x p l i c i t o r i m p li c i t e x a m p l e s o f e m p o we r m e n t i n h e r b i r t h, d e s p i t e t h e f ac t t h a t s h e h a d a v e r y p o s i t i ve e x p e r i e n ce M a ny o f my o u t o f h o s p i t a l pa r t i c i p a n t s discussed the ac t o f h a v i ng a n o ut o f h o s p i t a l b i r t h as e m p o we r in g. T h r e e p a r t i c i p a n t s ca t e g o r i ze d t h e i r b i r t hs a s e m p o we r i b eca u s e o f h o w n a t u r a l t h e e x p e r i e n ce wa s E m p o we r m e n t t h r o ugh a bi l i t y a n d ca p a bil i t y wa s d i s c u s s e d f i ve o f t h e n i ne p a r t i c i p a n t s T h i s t y pe o f e m p o we r m e n t r e l a t e d to r e c o gn i t i o n o f t h e h a r d w o r k a n d p r i d e i n p e r s o n a l ca p a b i l i t y a s s o c i a t e d w i t h g i v i ng b i r t h a n d o f t e n t im e s r e l a t e d to f e e l i ng e m p o we r e d b eca u s e o f t h e h a r d w o r k t h a t we n t in t o t h e i r l a b o r : S a r a h 2 7, B i r t h i n g H o m e B i r t h It w a s v e r y e m po w e r i n g I c a n s a y t h a t v e r y p r o ud t h a t I w a s I f e lt p r o ud a n d I f e l t v e r y g r at e f u l I f e l t b l e ss e d t h a t I w a s a b l e t o d o t h i s a nd a b l e t o t el l m y f r i e n ds t h a t u h m, uh m t h a t I d i d it I w a n t e d t o b e a b l e t o p r ov e t h a t I c o u l d do it A m a n d a 3 1 H o me b i r t h I f e l t v e r y p r o ud. It t oo k a l o t o f w o r k t o do i t J e ss i c a 2 5, H o me b i r t h I f ee l l i ke m a de i t T h r e e p a r ti c i p a n t s d i r ec tl y d i s c u ss e d t h ei r s u cce s s a t t h i s t y pe of n at u r a l b i r t h

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54 a s b e i n g p a r ti c u la r l y e m po w e r i n g b e c a u s e of t h e f ea r t h a t ou r s o c i e t y h o l ds a b o ut o u t o f h o s p i t a l b i r t h i ng: L o r o 34, H o me b i r t h: t a ke b a c k y o ur o w n p o w e r y o u kno w ? D o n l e t t h e f e a r o f o t h e r p e o p l e c o n t r o l t h e o u t c o m e of yo u b i r t h A n d t h at i t r ea ll y e m po w e r i n g I t h i n k w o m e n t o d a y t h e y g e t l o c k e d up i n f e a r b ec a u s e it n o t t h e n o r m y o u k n o w ? B ut it b e c o m i n g t h e n o r m n o w s l o w l y D i s c u ss i o ns li ke t h e s e h i g hl i g h t t h a t s o m e p a r t i c i p a n t s b e l i e v e d t h e c h o i c e to p a r t i c i p a t e i n a l e s s s o c i ally acce p t a b l e w a y o f b i r t h i ng is a s o u r c e o f p o we r L o r o s s t a t e m e n t f o c u s e s o n t h e f o r got t e n n a t u r a l a bil i t y o f w o m e n a n d r e j ec t in g t h e h o s p i t a l a n d t h e f ea r t h a t s h e s ees a ss o c i a t e d w i t h i t a n d s u cce ss f u lly g i v i ng b i r t h w i t h o u t m e d i c a t i o n i n t h e h o m e i s a w a y t o e m p h a s i z e t h e f ac t t h a t b i r t h in g c a n b e a n a t u r a l n o n m e d i c a l i ze d p r o ce ss D i s e m po w e r m e nt in t he O u t o f Ho s pi t al Sa m p l e One of the ways women in the out of hospital sample faced risk for disempowerment was through negative reactions to their choice of birth and birth setting. Although none of the participants explicitly f out of the participants faced some form of a negative reaction for choosing an out of hospital birth, whether it was with this birth, or a previous out of hospital birth. Three of the participants mentioned that negative reactions from family members seemed to lessen after the first out of h o s p i t a l b i r t h a n d t w o o f t h e s e i n d i v i d u a l s n o t e d t h a t t h e y f e l t n o n e g a t iv e r eac t i o n s du r in g t h e i r l a s t b i r t h e v e n f r o m t h e s e s a m e f a mily m e m be r s Ne g a t iv e

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55 r eac t i o n f o r p a r t i c i p a n t s r a n g e d f r o m p a l p a b l e b ut s u b d ue d d i s c o m f o r t, to qu e s t i o n i ng o f c h o i ce s o f t e n w i t h p a r t i c u l a r c o n ce r n t o s a f e t y to o u t r i g h t i n s u l t o f t h e in d i v i du a l o r t h e i r b i r t h p l a n M o s t n e g a t i ve r eac t i o ns c a m e f r o m l o v e d o n e s e i t h e r i n t h e f o r m o f f a mily o r f r i e n d s b ut t h e r e wa s a l s o s o m e m e n t i o n o f n e g a t ive r eac t i o n s f r o m acq u a in t a n c e s A g oo d d ea l o f c r i t i q u e s a b o ut p a r t i c i p a n t s b i r t h i n g a b i l i t y f o c u s e d o n a l ac k o f c o n f i d e n c e i n t h e ca p a bil i t y o f t h e i r b o d i e s F o ur p a r t i c i p a n t s d i s c u ss e d t h e i r b od y m o s t o f t en t h e i r s i ze a s a w a y i n w h i c h o t h e r s t r i e d to p o s i t i o n t h e m a s l ac k i ng p o we r T h e s e p a r t i c i p a n t s w h o a l l ca t e g o r i ze d t h e m s e l v e s a s s m a l l f e l t t h a t o t h e r s v i ewe d t h i s a s a r ea s o n t h a t t h e y w o u l d n o t b e ab l e to g iv e b i r t h o u t s i d e o f t h e h o s p i t a l s e tt in g. S a r a h f r a m e d t h is c o n ce p t u a li za t i o n w i t h i n a m e d i c a l i ze d u n d e r s t a n d i ng o f w h o ca n a n d c a n n o t g iv e b i r t h s t a t in g t h a t s h e t h o ug h t o t h e r s p e r c e iv e d h e r a s a u t o m a t i c a lly b e i ng m o r e p r o n e f o r a C e s a r ea n s ec t i o n b e c a u s e o f h e r s m a l l s i z e A n o t h e r p a r t i c i p a n t N i c o l e c o nn e c t e d h e r s i z e a n d g e n d er p r e s e n t a t i o n t o s o c i e t a l c o n ce p t i o n s o f p o we r a n d a bil i t y : N i c o l e 27, H o me b i r t h p e t i t e v e r y f e mi n i n e I t h i nk p e o p l e d o n s e e a l o t o f po w e r a nd u n fo r t u n at e l y I t h i n k a s w o m e n w e v e c o m e a l o n g w a y b ut t h e r e a l o n g w a y t o g o a nd s o w h e n yo u s e e t h i s v e r y p e tit e f e m i n i z e d w o ma n yo u ma y n o t s e e h e r, p e r ce i v e h e r a s s o m e b o d y w h o i s s t r o n g o r p o w e r f ul o r ca n do a n d c o n qu e r h a r d t h i n g s li ke h a v e a b a by n at u r a l l y a t h o m e E ac h o f t h e s e i n d i v i d u a l s we r e s u cc e s s f u l a t b i r t hi n g o u t s i de o f t h e h o s p i t a l s o t h e s e c o n ce p t u a li za t i o n s a b o ut t h e i r s i z e a n d a bil i t y w e r e d i s c r e d i t e d, p r o v i d in g a f u r t h e r s o u r c e o f e m p o we r m e n t t h r o ugh o v e r c o mi ng p e r ce p t i o n s o f in a bil i t y o r l a c k o f p o we r

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56 A n o t h e r c o m m o n t h e m e f o r n e g a t i ve r eac t i o n s w a s s t a t e m e n t s a b o ut l ac k o f s a f e t y o r acce s s to m e d i c a l in t e r v e n t i o n S i x o f t h e p a r t i c i p a n t s f ace d n e g a t iv e r ea c t i o ns f r o m o t h e r s w h i c h f e ll in t o t h i s ca t e go r y C o mm e n t s l a r g e ly b r o ke d o w n in t o t w o d i f f e r e n t c a t e g o r i e s : f ea r f o r s a f e t y o f m o t h e r a n d c hi l d a n d f ea r o f p a in : A m a n d a 3 1 H o me b i r t h It r a n f r o m f r o m s t r a i g ht o ut A r e yo u s t u p i d? D o yo u w a n t t o k i l l y o ur b a b y ? t o t h a t l e g al ? J e ss i c a 2 5, H o me b i r t h O n e f r i e n d w i f e w a s li ke Y o u d i d t h i s li ke t r i b a l s t y l e W h y w o u l yo u go t o t h e h o s p i t al ? S h e l i ke T h i s i s b a s i c a l l y t h e s am e t h i ng a s h a v i n g a b a by o ut i n t h e w oo d s L o r o 34, H o me b i r t h, quo t i ng s i s t e r H ow a r e yo u g o i n g t o g e t t h r o u g h t h a t ? b ec a u s e s h e t h o u g ht t h a t b e c a u s e s h e r u n s t r i at h l o n a n d yo u k n o w h e r p a i n t o l e r a n c e i s a l o t h i g h e r T w o o f t h e p a r t i c i p a n t s u t i l i ze d t h e mi d w i v e s h e l p i n o r d e r to d e a l w i t h t h e s a f e t y c o n ce r n s o f t h e i r l o v e d o n e s I n ea c h o f t h e s e c a s e s a mi d w i f e d i s c u s s e d v a r i o us b i r t h i ng a n d s a f e t y p r ac t i c e s i n o r d e r to a ll e v i a t e f a mily m e m b e r s f ea r s E ac h p a r t i c i p a n t s was a b l e to u t ili z e t h e k n ow l e dge o f t h e mi d w i f e i n o r d e r to p r e v e n t f u r t h e r n ega t i ve in t e r ac t i o n s a n d n o t e d h o w t h e i r l o v e d o n e s we r e p r e v i o u s ly m i s i n f o r m e d a b o ut m id w i f e r y a n d h o m e b i r t h N o n e o f m y p a r t i c i p a n t s h a d a ny s e r i o us m e d i ca l c o m p l i ca t i o n s w i t h i n t h e i r l a b o r s o p e o p l e s c o n ce r n s a b o ut t h e s a f e t y r i s k s o f t h e i r b i r t h we r e l e f t un f ou n d e d. L i k e t h e p r e v i o us d i s c u ss i o n o f in d i v i du a l s b od i e s a n d d i s e m p o we r m e n t t h e s e u l t im a t e l y f a l s e n e g a t iv e s t a t e m e n t s we r e s im p ly r ec o u n t e d as b e i ng o v e r d r a m a t i c o r f ea r b a s e d. H o we v e r i t w o ul d be in t e r e s t in g to s e e h o w t h e s e

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57 t y p e s o f c o mm e n t s m a y a ff ec t a n in d i v i du a l w h o s e o u t o f h o s p i t a l b i r t h m a y h a ve e n d e d i n s o m e s o r t o f h e a l t h e m e r g e n c y o r e v e n t r a g e d y C o m p a r i s on of E m po w e r m e nt f or E a c h Sub Sa m ple T h e in t e r v i e w s f r o m b o t h s u b s a m p l e s h i g hl i g h t t h a t e m p o we r m e n t i n t h e b i r t h s e t t in g is a v a r i e d e x p e r i e n c e a l t h o ugh m o r e c o m m o n a l i t i e s we r e f o u n d i n e x p e r i e n c e s o f e m p o we r m e n t i n t h e o ut o f h o s p i t a l s e tt in g t h a n i n t h e h o s p i t a l s e t t in g. P a r t i c i p a n t s i n t h e o u t o f h o s p i t a l s e tt in g we r e m o r e li k e ly t o r e l a t e t h e i r b i r t h c h o i c e s a n d bi r t h s e t t i n g t o i n h e r e n t e m p o we r m e n t a n d we r e a l s o m o r e li k e ly t o d i s c u s s t h e i r b od y a s a n i n h e r e n t s o u r c e o f t h e i r p o we r H o we v e r o u t o f h o s p i t a l p a r t i c i p a n t s i n m y s a m p l e a l s o f ace d m o r e e x p e r i e n ce s o f n e g a t iv e a n d o f t e n h u r t f u l in t e r ac t i o n s r e l a t e d to b i r t h p l a n s T h o ugh t h i s d i d n ot s e e m to h a v e a n e g a t iv e e ff e c t o n a ny o f t h e p a r t i c i p a n t s e x p e r i e n c e s o f e m p o we r m e n t b ut w e d o n ot k n o w h o w t h e s e p a r t i c i p a n t s in t e r n a l i ze d t h e s e c o mm e n t s b e f o r e t h e y g a v e b i r t h o r t h e e ff ec t t h a t t h e s e t y p e s o f c o mm e n t s h a v e o n w o m e n w h o b i r t h o u t o f t h e h o s p i t a l i n g e n e r a l I n b o t h s a m p l e s in d e p t h d i s c u s s i o n s o f e m p o we r m e n t r e l a t e d to o v e r c o mi ng d i ff i c u l t e x p e r i e n c e s I n d e p t h d i s c u s s i o ns o f e m p o we r m e n t f r o m t h e h o s p i t a l s e tt in g a l l r e l a t e d to o v e r c o mi ng a d i f f i c u l t e x p e r i e n c e w i t h p r e g n a n c y a n d/ o r b i r t h T h i s e x p r e ss i o n o f d ee p e m p o we r m e n t m a y r e l a t e to o v e r c o mi ng a d i f f i c u l t s i t u a t i o n t h e r e f o r e c o n ce p t u a li z in g o n e s e l f a s p a r t i c u l a r l y p o we r f u l W hi l e b i r t h i s i n a n d o f i t s e lf o f t e n an i n c r e d i b ly t r yi ng e x p e r i e n c e a n d t h i s i s m o s t o f t e n t h e e m p o we r m e n t t h a t m y o t h e r h o s p i t a l p a r t i c i p a n t s d i s c u ss e d, t h e p a r t i c i p a n t s w h o g a v e in d e p t h d i s c u ss i o n s a l s o h a d to o v e r c o m e o t h er f ac t o r s s u c h t h e po t e n t i a l f o r t h e l o s s o f t h e l i f e ( e i t h e r t h e i r s o r t h e i r i n f a n t s ) o r a n u n w a n t e d C s ec t i o n W hi l e t h e o t h e r p a r t i c i p a n t s we r e s t il l

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58 e m po we r e d by t h e a bil i t y t o g iv e b i r t h t h e y h ad f ewe r f o r ce s to o v e r c o m e i n t h e i r l a b o r w h i c h m a y h a v e c r ea t e d a d i ff e r e n t e x p e r i e n c e o f e m p o we r m e n t f o r t h e m. T h e s t r e n g t h o f e m p o we r m e n t w h e n i t i n v o lv e s o v e r c o mi ng m o r e t h a n j u s t t h e ph y s i c a l o b s t a c l e o f b i r t h i s f u r t h e r s upp o r t e d by t h e e x p e r i e n c e o f m y o u t o f h o s p i t a l s a m p l e B y r e j ec t in g n o r m a t iv e b i r t h p r ac t i c e s t h e s e p a r t i c i p a n t s f ace d r i s k f o r a m u c h g r ea t e r d e a l o f c r i t i c i s m a n d we r e s u b j ec t to m o r e d i r ec t a t t ac ks on t h e i r p e r s o n a l p o we r B eca u s e a l l o f m y p a r t i c i p a n t s f r o m t h e o u t o f h o s p i t a l s a m p l e f ace d n e g a t iv e r eac t i o n s t o wa r ds t h e i r o u t o f h o s p i t a l b i r t hs a t s o m e p o in t s u cce s s f u lly b i r t h i ng o u t o f h o s p i t a l s h o we d t h a t t h e y c ou l d o v e r c o m e n o t o n l y t h e d i ff i c u l t i e s o f l a b o r b u t a l s o m a in t a i n t h e i r p e r s o n a l a bil i t y t o r e j e c t t h e e x p e c t e d h o s p i t a l b i r t h Ne g a t iv e r eac t i o n w hi l e c i t in g in d i v i du a l s s i ze s a f e t y c o n ce r n s a n d c o n ce r ns a b o ut a b i l i t y c ou l d a l s o b e s e e n a s a n a t t e m pt to p u t p r e ss u r e o n t h e s e in d i v i du a l s t o c o n f o r m t o t h e s t a n d a r d h o s p i t a l b i r t h O n e p l ac e w h e r e e v i d e n c e i s f o u n d f o r t h i s i n t h e h o s p i t a l s a m p l e i s t h r o ugh T a b a t h a s d i s c u s s i o n o f h e r p l a n n e d C s e c t i o n B e f o r e in d i v i d u a l s kn e w t h a t s he wa s s c h e d u l i ng h e r o w n C s ec t i o n f o r a m e d i ca l ly n ece s s a r y r e a s o n s h e d i s c u ss e d g e tt in g n e g a t iv e r eac t i o n s f r o m t h e m W h il e h e r b i r t h f e ll o n t h e o t h e r e n d o f t h e s p ec t r um a s f a r as m e d i c a l in t e r v e n t i o n i s c o n ce r n e d, o u t s i d e r r eac t i o n h i g hl i g h t e d a n a t t e m pt ( c o n s c i o us o r n o t ) to r e g u l a t e b i r t h A s u cce ss f u l b i r t h o u t o f h o s p i t a l o v e r c o m e s t h e s e a t t e m p t s to c o n s t r a i n a n in d i v i du a l s a bil i t y by p r o v in g t h a t o t h e r w a y s o f b i r t h i ng c a n be j u s t a s s u cce s s f u l b ut t h i s m a y a l s o b e t h e r ea s o n w hy t h e t w o p a r t i c i p a n t s w h o h a d to t r a n s f e r to t h e h o s p i t a l h a d m o r e c o n f li c t e d f e e l i ngs a b o ut t h e i r b i r t h C h a r l o t t e s t a t e d t h a t s h e h a d b e e n n a i v e w hi l e N in a s t a t e d t h a t s h e f e l t li k e a f a i l u r e f o r t r a n s f e r r in g. A l t h o ugh b o t h o f

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59 t h e s e in d i v i du a l s f o u n d e m p o we r m e n t i n o t h e r wa y s t h e s e s t a t e m e n t s p r o v i de p o t e n t i a l e v i d e n c e t h a t i n d i v i du a l s w h o a r e n ot s u cce s s f u l a t b i r t h i ng o u t o f h o s p i t a l a n d t h e r e f o r e u n a b l e to o v e r c o m e t h e s t a t us q u o m a y b e a t g r e a t e r r i s k f o r f e e l i ngs o f d i s e m p o we r m e n t r e l a t e d s p e c i f i ca lly t o d e s i r e d b i r t h s e tt in g. M o r e r e s ea r c h i n t h i s a r e a w o u l d p r o v i d e in t e r e s t in g i n s i g h t in t o h o w t h e s e in d i v i du a l s c o pe w i t h a c h a n ge i n s e tt i n g. D i s c u ss ion T h i s s ec t i o n w i ll f u r t h e r o u t li ne s o m e o f t h e im p l i c a t i o n s f o r c o n t r o l a n d e m p o we r m e n t w i t h i n t h i s s t u d y a n d a l s o c o nn e c t t h e f i n d i ngs w i t h p r e v i ou s l i t e r a t u r e I n a d d i t i o n i t w i ll t r ac k s upp o r t a n d h o w s uppo r t wa s c o n n ec t e d to c o n t r o l a n d e m p o we r m e n t w i t h i n t h i s s t u d y I t wa s c l ea r t h a t o u t o f h o s p i t a l p a r t i c i p a n t s a n d h o s p i t a l p a r t i c i p a n t s h a d d i ff e r e n t e x p ec t a t i o n s o f w h a t e x p e r i e n c e s o f e m po we r m e n t a n d c o n t r o l w o u l d b e i n t h e i r b i r t h s P a r t i c i p a n t s w h o p l a n n e d t o b i r t h o u t s i d e o f t h e h o s p i t a l p l ace d a g r ea t e r d ea l o f e m p h a s i s o n t h e i m p o r t a n c e o f c o n t r o l o v e r t h e i r b i r t h s e t t in g a n d g a v e m o r e d e t a il e d e x p l a n a t i o n s o f t h e i r e x p e r i e n c e s o f e m p o we r m e n t T h e r e i s e v i d e n c e w i t h i n my s u b s a m p l e s t h a t h o s p i t a l p a r t i c i p a n t s d i d h a v e l e s s c o n t r o l o v e r t h e d e c i s i o ns s u rr o u n d i ng t h e i r b i r t h a l t h o ugh p a r t o f t h i s m u s t b e a t t r ib u t e d to t h e t h r e e h i g h e r r i s k p r e g n a n c i e s a n d b i r t h s w h i c h we r e i n t h i s s u b s a m p l e I t i s a l s o i m p o r t a n t to c o n s i d e r t h a t i n d i v i du a l s w h o b i r t h w i t h i n t h e h o s p i t a l m a y n o t h a v e w a n t e d a s m u c h c o n t r o l o v e r d e c i s i o n m a k i ng, f e e l i ng c o m f o r t a b l e l ea v in g t h e d e c i s i o n m a k i ng to t h e i r ca r e p r o v i d e r T h i s d i f f e r e n c e i n p e r s o n a l p r e f e r e n c e f o r c o n t r o l i s s upp o r t e d by t h e t h r ee p a r t i c i p a n t s w h o p l a nn e d to b i r t h o u t o f h o s p i t a l a n d t r a n s f e rr e d a t s o m e p o in t du r in g t h e i r p r e g n a n c y a n d l a b o r T h e s e in d i v i du a l s c o m p r i s e d t h e

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60 m a j o r i t y o f h o s p i t a l p a r t i c i p a n t s w ho s t a t e d t h a t t h e y h a d i s s u e s w i t h c o n t r o l o v e r d e c i s i o n m a k in g. De s i r e to b i r t h o u t o f h o s p i t a l is likely r e l a t e d to a p r e f e r e n c e f o r c o n t r o l o v e r d e c i s i o n m a k i ng. T h i s p r e f e r e n c e m a y r e l a t e to t h e d i a l o gue put f o r t h i n p a r t by t h e n a t u r a l b i r t h i n g m o v e m e n t w h i c h d i s c u s s e s i n d i v i d u a l c o n t r o l a s p a r t i c u l a r ly i m p o r t a n t to t h e o u t o f h o s p i t a l e x p e r i e n ce ( C a r t e r 2010; S h a w a n d K i t z i ng e r 2005) I n d i v i du a l s w h o d e s i r e m o r e c o n t r o l m a y h a v e b e e n d r a w n to t hi s a s p ec t o f t he o u t o f h o s p i t a l e x p e r i e n ce F i n d i ngs r e l a t e d to c o n t r o l i n b o t h s u b s a m p l e s c a n a l s o b e li nk e d t o G r ee n a n d B a s t o n s ( 2003) t h r e e t y p e s o f c o n t r o l : c o n t r o l o v e r o n e s b e h a v i o r c o n t r o l du r in g c o n t r ac t i o n s a nd c o n t r o l o v e r s t a f f C o n t r o l o v e r o n e s b e h a v i o r wa s n ot f o u n d to b e p a r t i c u l a r l y i m p o r t a n t to i n d i v i du a l s e x p e r i e n ce s a l t h o ugh t h e r e we r e m u l t i p l e i n s t a n c e s i n ea c h s u b s a m p l e w h e r e i n d i v i du a l s d i s c u ss e d ac t in g i n a w a y t h e y w ou l d u s u a l ly n o t h a v e S o m e t im e s t h e s e c o n ce p t i o ns we r e p a r t i c u l a r ly n e g a t iv e f o r e x a m p l e a h o s p i t a l p a r t i c i p a n t r e f e rr e d to h e r s e l f a s a l i tt l e d e m o n b e f o r e s he got h e r e p i du r a l C o n t r o l o v e r c o n t r a c t i o n wa s f o u n d to b e i m p o r t a n t i n b o t h s u b s a m p l e s a s m u l t i p l e p a r t i c i p a n t s i n ea c h s u b s a m p l e d i s c u ss e d t h e a b i l i t y ( o r l a c k t h e r e o f ) to c o n t r o l t h e i r b od i e s du r in g c o n t r a c t i o n s I n t h e h o s p i t a l s a m p l e t h i s m o s t l y i n v o l v e d t h e u s e of m e d i c a l in t e r v e n t i o n w hi l e t h e o u t o f h o s p i t a l s a m p l e d i s c u s s e d l ea r n i ng t o d e a l w i t h o r acce p t t h e p a in C o n t r o l o v e r s t a f f wa s f o u n d t o b e m o r e r e l e v a n t to m y o u t o f h o s p i t a l s a m p l e a l t h o ugh t w o p a r t i c i p a n t s i n t h e h o s p i t a l s a m p l e a l s o d i s c u s s e d t h i s t y pe o f c o n t r o l a s b e i ng i m p o r t a n t to t h e m A l t h o ugh t h e r e we r e d i f f e r e n ce s i n t h e e x p e r i e n c e o f e m p o we r m e n t e x p r e s s i o n s o f f e e l i ngs o f e m p o we r m e n t we r e c o n s i s t e n t t h r o ug h o u t b o t h s u b s a m p l e s O u t o f

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61 h o s p i t a l p a r t i c i p a n t s we r e m o r e li k e l y t o f a c e n e g a t iv e r eac t i o n s t o t h e i r b i r t h p l a n o r s e t t in g, a nd o v e r c o mi ng t h e s e n e g a t iv e c o mm e n t s t h r o ugh a s u cce s s f u l o u t o f h o s p i t a l b i r t h p r o v i d e d a n a d d i t i o n a l s o u r c e o f e m p o we r m e n t T h i s f i n d i ng suggests h o w t h e s ub v e r s i ve n a t u r e o f o ut o f h o s p i t a l b i r t h i ng c r ea t e s e x t r a o b s t a c l e s n o t f o u n d i n t h e h o s p i t a l s e t t in g. I n d i v i du a l s m a y h a ve e x p e r i e n ce d e m p o we r m e n t s o s t r o n g l y b eca u s e t h e y f a ce d o t h e r s d i r ec t a t t e m p t s to d i s e m p o wer t h e m M u c h li k e c o n t r o l e m p o we r m e n t i s a n e x p e r i e n c e t h a t i s e x p l i c i t ly d i s c u ss e d by t h e o ut o f h o s p i t a l m o v e m e n t s o t h e s e p a r t i c i p a n t s f o c us o n t h i s e x p e r i e n c e m a y a l s o h a v e b e e n r e l a t e d to t h e d i s c o u r s e s u rr o u n d in g o u t o f h o s p i t a l b i r t h Suppo r t wa s c o n s i s t e n t l y b r o ug h t up by m y p a r t i c i p a n t s i n b o t h s u b s a m p l e s a s s o m e t h in g w h i c h wa s im p o r t a n t to t h e m A ll o f m y p a r t i c i p a n t s h a d l o v e d o n e present a t t h e i r b i r t h s e i t h e r f r i e n d o r f a mily m e m b e r s I n b o t h s u b s a m p l e s p a r t n e r s we r e t h e m o s t c o m m o n f o r m o f m a i n s upp o r t w i t h 15 o u t o f 16 p a r t i c i p a n t s h a v i ng t h e m p r e s e n t M o t h e r s we r e a n o t h e r c o m m o n s upp o r t s y s t e m w hi l e f a t h e r s we r e a m o ng t h e l e a s t c o m m o n Supp o r t p e o p l e we r e o f g r ea t im p o r t a n c e f o r t h e o u t o f h o s p i t a l p a r t i c i p a n t s i n g e n e r a l a n d p a r t i c i p a n t s i n e i t h e r s u b s a m p l e w h o h a d d i f f i c u l t b i r t h s T h e importance of support people for these situations m a y b e b ec a u s e t h e s e s i t u a t i o n s wa rr a n t e d e x t r a s uppo r t I n d i v i d u a l s h a v i ng d i f f i c u l t b i r t h s w h o f ace d a l a c k o f s upp o r t f r o m t h e i r l o v e d o n e s we r e m o r e li k e ly to h a v e n e g a t iv e c o n ce p t i o n s a b o ut t h e l ac k o f s upp o r t M y t w o p a r t i c i p a n t s w h o h ad r e l a t iv e ly u n c o m p l i ca t e d b i r t h s o n e i n h o s p i t a l a nd o n e o u t o f h o s p i t a l w h o f ace d l ac k o f s upp o r t f r o m l o v e d o n e s we r e a b l e to b r u s h a s i de t h e s e i n s t a n c e s a s a j o k e H o we v e r t h r e e o f m y p a r t i c i p a n t s w h o h a d m o r e d i f f i c u l t l a b o r s ( o n e i n h o s p i t a l a n d t w o o u t o f h o s p i t a l ) a n d f ace d a l ac k o f l o v e d o n e s upp o r t s ee m e d to dee p l y in t e r n a l i z e t h e s e e x p e r i e n c e s T h e s e f i n d i n g s h i g hl i g h t

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62 t h e im p o r t a n t r o l e s t h a t l o v e d o n e s p l a y a n d t h e i r p o t e n t i a l t o s h a pe e x p e r i e n c e i n t he b i r t h s e t t in g. De a li ng w i t h a n u n s upp o r t iv e l o v e d o n e m a y c o n t r ib u t e to a n e g a t iv e e x p e r i e n ce, a n d i t m a y a l s o m a ke d e a li ng w i t h o t h e r h a r d s h i ps du r in g l a b o r m o r e d i ff i c u l t L ac k o f s upp o r t m a y put in d i v i du a l s i n a p l ac e w h e r e t h e y f e e l l e s s a b l e t o e x e r t c o n t r o l o r l e s s li ke t h e y h a ve p e r s o n a l p o we r i n t h e i r b i r t h s e tt in g, a s l o v e d o n e s o p i n i o n s a n d ac t i o n s m a y b e d ee p ly i n f l u e n t i a l p a r t i c u l a r ly o n i n d i v i du a l s w h o a r e h a v i ng a d i f f i c u l t t im e b i r t h i ng f o r o t h e r r ea s o n s s u c h a s h i g h l e v e l s o f p a in. A n o t h e r im p o r t a n t t y pe o f s upp o r t wa s ca r e p r o v i d e r s uppo r t C a r e p r o v i d e r s upp o r t v a r i e d g r ea t l y b e t wee n t h e s u b s a m p l e s p a r t i c u l a r ly c o n ce r n i ng p r e n a t a l ca r e W hi l e m u l t i p l e p a r t i c i p a n t s i n t h e o u t o f h o s p i t a l s a m p l e d i s c u s s e d t h e im p o r t a n c e o f t h e i r r e l a t i o n s h i p w i t h t h e i r m i d w i f e a n d t h e e m o t i o n a l s upp o r t t h a t t h e y g a v e t h e m b e f o r e b i r t h o n l y o ne p a r t i c i p a n t i n t he h o s p i t a l s a m p l e n o t e d t h i s k in d o f r e l a t i o n s h i p w i t h t h e i r O B s T h i s m a y r e l a t e to a d i ff e r e n t ca r e s t yl e wh i c h f o c u s e s m o r e o n t h e m e d i c a l a s p e c t s o f p r e g n a n c y a n d a m o r e t y p i c a l d o c t o r p a t i e n t r e l a t i o n s h i p t h a n wa s f ou n d i n t h e mi d w i f e m o d e l F u r t h e r e v i d e n c e o f t h i s i s p r o v i d e d i n t h e f a c t t h a t n o p a r t i c i p a n t s b r o ug h t up t h e i r O B / G YN s p r o v i d i ng e m o t i o n a l s upp o r t d u r in g l a b o r w h il e 5 o f m y 8 o ut o f h o s p i t a l p a r t i c i p a n t s b r o ug h t up s p ec i f i c i n s t a n c e s o f t h e i r mi d w i f e d o in g s o P r e f e r e n c e f o r e m o t i o n a l s upp o r t f r o m c a r e p r o v i d e r m a y b e a n o t h e r r ea s o n w hy ce r t a i n in d i v i du a l s t e n d t o wa r ds o u t o f h o s p i t a l m i d w i f e l ea d ca r e T h e p a r t i c i p a n t s i n t h i s s t u d y s upp o r t e d previous research t h a t evidenced c l o s e r e l a t i o n s h i ps w i t h ca r e p r o v i d e r s as being m o r e c o m m o n i n t he o u t o f h o s p i t a l s e tt in g, a n d h a pp e n s l e s s i n t h e h o s p i t a l s e tt in g ( A n n a n d a l e 198 8 ; B ec k e t t a nd H o ff m a n 200 5 ; C a r t e r 2010; S h a w a n d K i t z i n g e r 2005) A l t h o ugh t h e e v i d e n c e w i t h i n t h i s s t udy i s i n n o w a y g e n e r a l i z a b l e t h e r e we r e

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63 in d i ca t i o ns t h a t ce r t a i n p a r t i c i p a n t s i n ea c h o f m y s u b s a m p l e s h a d f ac t o r s w h i c h ca u s e d t h e m t o f i t m o r e in t o ce r t a i n b i r t h s e tt in g. P r e f e r e n c e f o r g r e a t e r c o n t r o l o v e r d e c i s i o n m a k i n g, r e j ec t i o n o f m e d i c a l i za t i o n n a t u r a li ze d p e r ce p t i o n s o f b i r t h a nd a d e s i r e f o r a m o r e e m o t i o n a l r e l a t i o n s h i p w i t h ca r e p r o v i de r we r e s o m e o f t h e m a i n r ea s o ns in d i v i du a l s s h o we d p r e f e r e n c e to t h e o u t o f h o s p i t a l s e tt in g, e v e n if t h e y e n d e d up g i v i ng b i r t h i n h o s p i t a l F o r t h e t h r e e p a r t i c i p a n t s w h o d i d h a v e t o g iv e b i r t h a t t h e h o s p i t a l d e s p i t e p r e v i o us p l a ns to b i r t h o u t o f h o s p i t a l t h e s e p r e f e r e n ce s a r e e v i d e n ce d by t h e i r c r i t i qu e s o f t h e i n h o s p i t a l e nv i r o n m e n t E ac h o f t h e s e individuals made statements about lack of control, problems with medicalization in the hospital, and/or birth as a natural process faces too much intervention. A c c e s s to m e d i c a l in t e r v e n t i o n wa s t h e m a i n im pe t us f o r g i v i ng b i r t h in s i de o f t h e h o s p i t a l w i t h l im i t e d e v i d e n c e o f p r e f e r e n c e f o r f o l l ow i ng t h e s t a n d a r d b i r t h p r ot o c o l a s t r a d i t i o n S o m e p r e f e r e n c e f o r m e d i ca l in t e r v e n t i o n c o u l d a l s o b e a tt r ib u t e d to p a r t i c i p a n t s f ea r s o f t h e p e r c e i v e d n o n m e d i c a l i ze d/ u n s a f e o u t o f h o s p i t a l e nv i r o n m e n t T h e r e wa s no e v i d e n c e t h a t p a r t i c i p a n t s i n e i t h e r s u b s a m p l e we r e m o r e o r l e s s li k e ly t o f e e l e m p o we r e d, a n d w hi l e c o n t r o l o v e r d e c i s i o n m a k i ng v a r i e d, o n l y 4 o f m y 8 h o s p i t a l p a r t i c i p a n t s e x p r e s s e d c o n ce r n w i t h t h i s p r o v i d i ng e v i d e n c e t h a t s o m e i nd i v i du a l s m a y p r e f e r n o t to h a v e e x t e n s i ve c o n t r o l o v e r d e c i s i o n m a k in g du r in g t h e i r l a b o r T h i s f i n d i ng s upp o r t s B ec k e t t s ( 2005) w o r k o n t h i r d wa v e f e m i n i s t u n d e r s t a n d in g s o f b i r t h i ng w o m e n w h i c h a r gu e s t h a t in d i v i du a l p r e f e r e n c e m a y v a r y g r ea t l y a n d t h a t s o m e i n d i v i du a l s m a y a c t u a l l y b e b e s t s u i t e d to n ot h a v i ng a g r eat a m o u n t o f c o n t r o l o v e r t h e i r b i r t h s p r e f e r r in g o t h e r s m a ke d e c i s i o n s f o r t h e m H o we v e r t h i s s t udy d i d f i nd m o r e e v i d e n c e o f c o n t r o l o v e r d e c i s i o n m a k in g i n t h e o ut o f h o s p i t a l s u b s a m p l e a n d t h a t m u l t i p l e p a r t i c i p a n t s i n t h e h o s p i t a l s u b s a m p l e d i d

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64 f ac e a tt e m p t s to e x e r t c o n t r o l o v er t h e i r d e c i s i o n m a k i ng. F o r in d i v i du a l s w h o d o p r e f e r c o n t r o l o v e r d e c i s i o n m a k i ng, h a v i ng o t h e r s a t t e m pt to t ak e awa y t h i s c o n t r o l m a y b e a p a r t i c u l a r l y d i f f i c u l t e x p e r i e n ce F o r t h e p a r t i c i p a n t s i n t h i s s u b s a m p l e a t t e m p t s to t a ke b ac k c o n t r o l i n v o lv e d a g r ea t d ea l o f p e r s o n a l l a b o r a n d a d v o ca t in g, w o r k w h i c h m a y b e p a r t i c u l a r ly d i f f i c u l t to p e r f o r m du r in g l a b o r W hi l e b o t h o f t h e s e e nv i r o n m e n t s h a d a m a j o r i t y o f i n d i v i du a l s w h o we r e v e r y s a t i s f i ed w i t h t h e i r b i r t h i t i s im p o r t a n t to f u lly d r a w o ut t h e p o we r d i ff e r e n t i a l t h a t m a k e s b i r t h i ng i n h o s p i t a l s o m u c h ea s i e r t h a n b i r t h i ng o u t s i de o f t h e h o s p i t a l H o s p i t a l pa r t i c i p a n t s we r e s i g ni f i c a n t l y l e s s l i k e ly t o f ac e n e g a t i ve r eac t i o ns to t h e i r b i r t h s e tt in g o r p l a n p a r t i c u l a r ly f r o m f a mi ly I n g e n e r a l i n d i v i d u a l s w h o b i r t h w i t h i n t h e h o s p i t a l a l s o f ac e l e s s l e g a l b l o c ks t o t h e ir b i r t h p l a n s s u c h a s l e g i s l a t i o n w h i c h p r e v e n t s t h e m f r o m acce ss i ng t h e ca r e p r o v i d e r t h e y d e s i r e to a t t e n d t h e i r b i r t h or w h i c h p l a ce s t h e m i n a r i s k ca t e g o r y t h a t d e n i e s t h e m f r o m r ec e i v i ng m i d w i f e l ea d o ut o f h o s p i t a l ca r e We m u s t q ue s t i o n t h e im p e t us f o r c r i t i qu e s o n n a t u r a l b i r t h i ng. W hi l e m a ny i n d i v i d u a l s m a y l i ke to b e li e ve t h a t t h e i r c r i t i qu e s h a v e a s c i e n t i f i c b ac k i ng, m u c h o f t h e b a s i s f o r n e g a t i v i t y t o wa r ds o u t o f h o s p i t a l b i r t h i ng i s a s o c i e t a l c o n s t r u c t w h i c h v a l u e s t h e h o s p i t a l s e tt in g f o r b i r t h in g, a n d h o l ds n o n h o s p i t a l s e tt in gs s u s p ec t T h i s c u l t u r a l c o n ce p t i o n o f t h e r i g h t w a y t o b i r t h m e a n s t h a t m a ny d i ff e r e n t f a ce t s o f o u r s o c i e t y a r e i n f l u e n ced L a w m a k i ng, c o m m o n d i s c o u r s e m e d i a p r e s e n t a t i o n a n d w h a t w e t eac h o ur m e d i ca l p r o f e s s i o n a l s a r e a ll c u l t u r a l i n f l u e n c e s a n d a s l o ng a s w e r e l y o n n e g a t iv e c o n c e p t i o ns o f o u t o f h o s p i t a l b i r t h in d i v i du a l s w h o s ee k t h i s t y pe o f ca r e w il l f ac e g r ea t e r c h a ll e n g e s

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65 V C O NC L U S I ON T h e e v e n t s o f b i r t h a n d p r e g n a n c y a r e d ee p ly a f f e c t e d by h o w w e u n d e r s t a n d t h e m i n o ur s o c i e t y T h i s cultural influence a p p l i e s p a r t i c u l a r l y t o t h e ca r e p r o v i d e r s w h o a r e s ee n a s b e in g m o s t a pp r o p r i a t e to h e l p s o m e o n e g i v i ng b i r t h a n d t h e s e t t in g w h i c h i s t h o ug h t o f a s t h e b e s t p l ac e t o g iv e b i r t h B eca u s e b i r t h in g w i t h i n t h e h o s p i t a l w i t h a n O B / G Y N i s t h e n o r m in d i v i du a l s w h o s ee k o u t o f h o s p i t a l m i d w i f e r u n ca r e f ac e m o r e o b s t ac l e s T h e y m a y f ac e s c r u t i ny i n t h e i r c h o i c e s lim i t a t i o n i n a cce s s to t h i s k in d o f h e a l t h ca r e a n d e v e n l e g i s l a t u r e wh i c h m a k e s b i r t h i ng o u t o f h o s p i t a l w i t h i n t h e i r a r e a d i f f i c u l t o r i m p o s s i b l e T h e s e d i f f e r e n ce s i n a bil i t y t o acce s s o u t o f h o s p i t a l ca r e m a k e s e x a m i n a t i o n o f po t e n t i a l b e n e f i t s a n d c o n s o f ea c h o f t h e s e s e tt i n g s p a r t i c u l a r l y i m p o r t a n t T h i s s t u d y f o c u s e s o n t h e w a y s t h a t e m p o we r m e n t a n d c o n t r o l a r e a ff ec t e d by b i r t h i ng s e tt in g a ca r e p r o v i d e r a n d p a y s p a r t i c u l a r a t t e n t i o n to t h e i n f l u e n c e t h at m e d i c a l i za t i o n h a s o n t h e s e e x p e r i e n c e s Within this research, there were some major differences between hospital and out of hospital car e. The most obvious difference each sub sample s reliance on medical intervention. While intervention was generally portrayed negatively in the out of hospital sample, it was a driving force for why individuals gave birth in the hospital setting, and hospital participants discussed greater fear associa ted with not having access to intervention. Rela tionships with care providers were also one of the most striking differences between samples, as more participants in the out of hospital sub sample discussed much more emot ionally close relationships with their care providers

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66 than their hospital bi rthing counterparts. Another major difference was reaction to participants births, evident in the negative reactions that were faced by out of hospital birthing participants. O n e r ea s o n t h a t a n in d i v i du a l m a y c h oo s e to b i r t h o u t s i de o f t h e h o s p i t a l i s i n c r e a s e d m e d i ca li z a t i o n M e d i c a l i z a t i o n i n v o l v e s u n d e r s t a n d i n g s d i ff e r e n t p r o b l e m s a n d li f e e v e n t s i n t e r m s o f a m e d i c a l f r a m ew o r k, a n d m o s t o f t e n i t i s ac t u a l ly o v e r m e d i c a l i za t i o n o r a t t e m p t s to u n d e r s t a n d a n d t r ea t p r o b l e m s o r li ve e v e n t s t h r o ugh a m e d i c a l f r a m ew o r k w h e n i t i s n o t ac t u a l ly n e c e s s a r y w h i c h i s e x a m i n e d. M u c h of t h e l i t e r a t u r e s u rr o u n d in g p o t e n t i a l p r o b l e m s w i t h o v e r m e d i ca li z a t i o n i n t h e h o s p i t a l s e tt in g i s f o c u s e d o n h o w i t m a y a f f ec t t h e in d i v i du a l I n c r ea s e d u s e o f in t e r v e n t i o n f ea r a ss o c i a t e d w i t h p r e g n a n c y a n d l e s s f e e l i n g s o f c o n t r o l o v e r d e c i s i o n m a k i ng h a v e a l l b e e n a r gu e d to b e a ss o c i a t e d w i t h m e d i c a l i za t i o n i n t h e h o s p i t a l e nv i r o n m e n t ( C a r t e r 2010; C h r i s t i ae n s a n d B r a ke 2011; C h e r v e n a k & M c C u l l o u g h 2005; M a r s h a ll & W oo ll e t t 2000; M oo r e 2011; R e i g e r Ke rr ee n & R h e a D e m p s e y 200 6 ; R o s e n t h al 2006; Z w e i g & O l i v e r 2009 ) H o we v e r v e r y f e w o f t h e s e s t u d i e s h a v e ac t u a l ly a t t e m p t e d to c o ll ec t d a t a f r o m in d i v i du a l s w h o h a v e g iv e n b i r t h i n t h e h o s p i t a l ( G r ee n a n d B a s t o n 2003; H e in z e a n d S l e i g h 2003) a n d o nly o n e o f t h e s t ud i e s t h a t I f o u n d u t ili z e d p a r t i c i p a n t n a rr a t iv e s ( C a r t e r 2010 ) T h i s s t u d y a im e d t o f o c us o n e x p e r i e n ce s o f c o n t r ol a n d e m p o we r m e n t a n d h o w t h e y a r e a ff ec t e d by b i r t h s e tt in g. W i t h i n my t o t a l s a m p l e b i r t h s e t t in g wa s f ou n d to h a v e a n e ff ec t o n c o n t r o l a n d e m p o we r m e n t I n p a r t i c u l a r t h i s s t ud y s upp o r t e d t h e n o t i o n t h a t s o m e in d i v i du a l s m a y e x p e r i e n c e l e s s c o n t r o l o v e r d e c i s i o n m a k i ng i n t h e h o s p i t a l H o we v e r t h e s t udy a l s o h i g hl i g h t e d t h a t t hi s c o n t r o l o v e r d e c i s i o n m a k i ng

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67 m a y n ot b e wa n t e d by a ll i n d i v i du a l s P a r t i c i p a n t e m p o we r m e n t wa s f o u n d i n b o t h s u b s a m p l e s a l t h o ugh p a r t i c i p a n t s w i t h m o r e d i f f i c u l t b i r t h s a n d t h o s e w h o b i r t h e d o u t o f h o s p i t a l g a v e m o r e d e t a il e d d e s c r i p t i o ns o f t h e i r e m p o we r m e n t h i g hl i g h t in g a po t e n t i a l d i ff e r e n c e b e t we e n k in ds o f e m p o we r m e n t w h i c h c a n be e x p e r i e n ce d du r in g b i r t h T h o ugh t h e r e s u l t s o f t h i s s t u d y a r e n o t g e n e r a li za b l e t h e r e i s s o m e e v i d e n c e t h a t t h e r e s u l t s r e l a t e d to p r ev i o us r e s ea r c h o n t h e s t udy o f b i r t h C o n t r o l wa s f o u n d to b e m o r e i m p o r t a n t i n t h e o u t o f h o s p i t a l e nv i r o n m e n t a n d c l o s e r r e l a t i o n s h i ps w i t h ca r e p r o v i d e r s we r e f ou n d to ex i s t I n s uppo r t o f C a r t e r s ( 201 0 ) r e s ea r c h d i s c u ss i o ns o f c o n t r o l we r e a l s o f o u n d to b e c o m p l e x a s l a b o r in g mi x e d e x p e r i e n ce s o f b e i n g i n c o n t r o l ( i e a bi l i t y t o m a ke d e c i s i o n s ) a n d o ut o f c o n t r o l ( i e a b i l i t y t o c o n t r o l t h e ph y s i ca l p r o ce s s o f l a b o r) P a r t i c i p a n t s i n t h i s s t udy a l s o s up p o r t e d t h e n o t i o n t h a t b i r t h in g p r e f e r e n c e s a r e v a r i e d a n d c o m p l e x a n d t h a t f o r s o m e i n d i v i du a l s e m p o we r m e n t wa s e v e n f r a m e d a s b e i n g g a i n e d t h r o ugh a h i g hly m e d i ca li z e d e nv i r o n m e n t ( C h e y n e y 2008 ) T h i s s t u d y a l s o p r o v i d e d e v i d e n c e o f a p o we r d i ff e r e n t i a l w h i c h e x i s t s b e t we e n i n d i v i du a l s w h o g iv e b i r t h w i t h i n t h e h o s p i t a l a n d t h o s e w h o b i r t h o u t o f h o s p i t a l T h e m a j o r i t y o f m y p a r t i c i p a n t s i n b o t h s u b s a m p l e s we r e q u i t e s a t i s f i e d w i t h t h e i r b i r t h b ut p a r t i c i p a n t s r e f e r e n c e f o r m e d i ca l in t e r v e n t i o n o r n a t u r a li ze d u n d e r s t a n d i n g s o f b i r t h p l a y e d a l a r ge p a r t i n d i c t a t in g w h i c h s e tt i n g t h e y we r e c o m f o r t a b l e w i t h. A l t h o ugh t h e r e we r e n o p a r t i c i p a n t s w h o h a d to b i r t h o u t o f h o s p i t a l d e s p i t e wa n t in g to b i r t h i n h o s p i t a l m y t h r e e p a r t i c i p a n t s w h o we r e a l l u n a b l e t o b i r t h o u t o f h o s p i t a l ea c h s h o we d s o m e d i s c o m f o r t w i t h t h e h o s p i t a l e nv i r o n m e n t a n d d i f f i c u l t y d e a l i ng w i t h t h e c o n t r o l t h e y f e l t wa s e x e r t e d o v e r t h e m i n t h i s s e tt in g. T h i s finding suggests t h a t t h e r e

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68 a r e ce r t a i n in d i v i du a l s w h o j u s t f i t b e tt e r i n t h e o u t o f h o s p i t a l m o d e l p a r t i c u l a r l y t h o s e w h o a r e in t e r e s t e d i n g r ea t c o n t r o l o v e r d e c i s i o n m a k i ng a n d m o r e n a t u r a li ze d / l e s s m e d i c a l i ze d u n d e r s t a n d i ngs o f b i r t h M y t w o p a r t i c i p a n t s w h o t r a n s f e rr e d to t h e h o s p i t a l du r i ng l a b o r a n d o n e p a r t i c i p a n t w h o h a d t o t r a n s f e r to a t r a d i t i o n a l O B / GY N f r o m h e r m i d w i f e ca r e p o in t to p o s s i b l e im p l i ca t i o n s f o r r e s ea r c h w h i c h f o c us o n h o w in d i v i du a l s e m o t i o n a lly m a n a ge b i r t h i ng o u t s i de o f t h e e nv i r o n m e n t t h e y h a d o r i g i n a lly c h o s e n in c l u d i ng h o w t h e y d ea l w i t h c h a n g e s i n c a r e p r o v i d e r s in t e r v e n t i o n s t yl e s a n d p h y s i c a l s e tt in g. A s s t a t e d ea r li e r a l l p a r t i c i p a n t s w h o b i r t h e d o u t o f t he h o s p i t a l f ace d n e g a t iv e r eac t i o ns f r o m o t h e r s b ec a u s e o f t h e i r b i r t h c h o i ce I f t h e s e r e s u l t s we r e s h ow n to b e ge n e r a l i z a b l e a n o t h e r in t e r e s t in g im p l i ca t i o n f o r r e s ea r c h o n e m o t i o n a l m a n a g e m e n t w o u l d be a s t udy w h i c h f o c u s e s s p ec i f i c a lly o n h o w in d i v i du a l s w h o b i r t h o u t o f h o s p i t a l m a n a ge t h e s e n e g a t iv e r eac t i o n s T h i s r e s e a r c h f o c u s e d o n t h e p o s t p a r t u m p e r i o d, a n d s t ud i e s w h i c h f o c us o n h o w p r e g n a n t in d i v i du a l s e x p e r i e n c e a n d m a n a ge t h e s e r eac t i o n s w ou l d p r o v i de in t e r e s t in g i n s i g h t in t o t h e e ff ec t t h a t t h e s e r eac t i o n s h a v e o n in d i v i d u a l s b e f o r e g i v ing b i r t h O f p a r t i c u l a r in t e r e s t f o r t h e s ec t i o n f o c u s i ng o n h o w p a r t i c i p a n t s f e l t a b o u t t h e s e r eac t i o ns i n t h e p o s t p a r t um p e r i o d w o u l d b e a c o m p a r i s o n o f p a r t i c i p a n t s w h o we r e s u cce s s f u l a t b i r t h in g o u t o f h o s p i t a l a n d t h o s e w h o we r e n ot. T h i s m a y g iv e i n s i g h t in t o p o s s i b l e d i ff i c u l t i e s w i t h d e f l ec t in g po t e n t i a l d i s e m p o we r m e n t w h e n in d i v i d u a l s we r e n o t a b l e t o o v e r c o m e t h e s t a t us q u o o f b i r t h in g w i t h i n t h e h o s p i t a l A p o pu l a t i o n n o t r e p r e s e n t e d i n m y s a m p l e b ut f o r w h o m my r e s ea r c h m a y h a v e s o m e in t e r e s t in g im p l i ca t i o n s w o u l d b e i n d i v i d u a l s w h o b i r t h e d v i a n o n m e d i c a lly n ece ss i t a t ed p l a n n e d C s e c t i o n B o t h s t ud i e s f o c u s i ng o n t h e s o c i e t a l

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69 r eac t i o n t h a t in d i v i d u a l s c h oo s in g n o n n o r m a t i v e h i g h l y in t e r v e n t i o n a l h o s p i t a l b i r t h s a n d c o m p a r a t i ve s t ud i e s f o c u s i ng o n t h e r eac t i o n s t h a t o u t o f h o s p i t a l b i r t h in g i n d i v i d u a l s a n d n o n n o r m a t iv e h o s p i t a l b i r t h in g i n d i v i du a l f ac e w ou l d g iv e i n s i g h t in t o t h e wa y t h a t b i r t h i ng i s r e g u l a t e d by s o c i e t a l c o n ce p t i o ns o f w h a t is n o r m a l T h i s w o r k w o u l d p r o v i de m o r e i n s i g h t in t o w h a t i s v i ewe d a s t h e r i g h t w a y to g iv e b i r t h a n d m a y p r o v i de a n in t e r e s t in g in s i g h t in to n e g a t iv e s o c i e t a l c o n ce p t i o ns r e g a r d ing in t e r v e n t i o n c o m m o n ly v i e we d a s o v e r m e d i ca l i z a t i o n w h i c h a r e m o s t l y a b s e n t f r o m t he l i t e r a t u r e ( C h e yn e y 2008 i s o n e o f a f e w e x c e p t i o n s ) S t ud i e s o n n o n m e d i c a lly n ec e s s i t a t ed s c h e d u l e d C s ec t i o n s m a y p r o v i de a n in t e r e s t in g c r i t i que to t h e m e d i ca li z a t i o n m o d e l w h i c h s h o w s t h a t e x t e n d in g too f a r aw a y f r o m t h e s o c i e t a l n o r m i n e i t h e r d i r ec t i o n w h e t h e r i t b e l a c k o f in t e r v e n t i o n o r in c r e a s e d u s e o f in t e r v e n t i o n i s u n d e r s t o o d a s p r o b l e m a t i c T h e s e s t u d i e s m a y p r o v i de g r ea t e r i n s i g h t in t o w h a t e x ac t l y t h e s t a n d a r i s w i t h i n o ur s o c i e t y f o r h o s p i t a l b i r t h i ng ca r e. O n e o f t h e m o s t im p o r t a n t im p l i ca t i o n s f o r f u r t h e r r e s ea r c h wa s t h i s s t u d y s f o cu s o n t h e qu a l i t a t iv e n a rr a t iv e s o f h o s p i t a l b i r t h in g w o m e n B eca u s e v o i c e s f r o m t h e s e pa r t i c i p a n t s a r e lim i t e d, i t i s n ec e ss a r y to g a i n m o r e d a t a a b o ut h ow h o s p i t a l b i r t h i ng p a r t i c i p a n t s f e e l a b o u t b i r t h, b i r t h s e t t in g, a n d b i r t h i ng c h o i c e s i n g e n e r a l M o r e r e s ea r c h n ee ds t o b e d o n e i n t h i s a r e a i n o r d er to g e t a c l ea r u n d e r s t a n d in g o f w h a t b i r t h i ng i n t h e h o s p i t a l i s li k e R e s ea r c h o f t e n f o c u s e s o n a ss u m p t i o n s b a s e d o n a n ec d o t a l e v i d e n ce i n s t ea d o f a c l ea r d a t a f r o m i n d i v i du a l s w h o h a ve ac t u a l l i v e d e x p e r i e n ce. W h e n c o n s i d e r in g a l i f e e v e n t a s i n f l u e n t i a l a s t h e b i r t h o f o n e s c hi l d, i t i s i m p o r t a n t to t r e a t eac h in d i v i d u a l w h i c h r e s p ec t c o m p a s s i o n a n d c o n ce r n f o r p e r s o n a l p r e f e r e n ce s W hi l e i t i s a f u n c t i o n o f m o d e r n m e d i c i ne t o k ee p in d i v i du a l s s a f e f r o m

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70 h a r m ev i d e nc e h a s s h o w n t h at o u t o f h o s p i t a l b i r t h i ng i s a p e r f ec t l y s a f e a l t e r n a t iv e f o r m a ny i n d i v i du a l s ( A m e r i c a n P u b l ic He a l t h A s s o c i a t i o n 2002; A n d e r s o n R E M u r phy P A 1995; Z w e i g & O li v e r 2009 ) De s p i t e t hi s researc h a l l o f m y pa r t i c i p a n t s w h o b i r t h e d o u t o f h o s p i t a l f ace d n e g a t iv e r eac t i o n s w h i c h p r o v i d ed e v i d e n c e t h a t b i r t h i ng o u t o f h o s p i t a l w a s a s ubv e r s i ve ac t w h i c h w e n t a g a i n s t s o c i e t a l n o r m s T h i s finding m a y h i g hl i g h t a n i ss u e w i t h a l l o w in g i n d i v i d u a l s w h o w i s h to r ece iv e a n a l t e r n a t iv e f o r m o f ca r e b e i ng a b l e t o acce s s i t b eca u s e t h e i r ac t i o ns do n ot f a l l w i t h i n t h e p r ec o n c e i v e d n o t i o n s of t h e r i g h t w a y t o g iv e b i r t h De p e n d i ng o n t h e in d i v i du a l s p e r s o n a l p r e f e r e n c e s b e i ng s h i f t e d to a b i r t h in g s e t t in g w h i c h t h e y a r e n o t c o m f o r t a b l e w i t h w h e t h e r i t b e i n h o s p i t a l o r o u t o f h o s p i t a l m a y b e po t e n t i a l ly h a r m f u l to t h e i r s a t i s f a c t i o n w i t h t h e b i r t h i ng p r o ce ss

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71 A P P E ND I X I n t e r vi e w Guide D e m o g r a ph i c s / F o u n d a t i o n a l qu e s t i o n s : H o w o l d a r e y o u? W h a t g e n d e r do y o u i d e n t i f y a s ? W h a t r ac e d o y o u i d e n t i f y a s ? W h e n d i d y o u g iv e b i r t h? W h e r e d i d y o u g i ve b i r t h? W a s t h i s y o ur f i r s t b i r t h? I f n o t, h o w m a ny o t h e r c h il d r e n h a v e y o u h a d ? W h e r e we r e t h e y b o r n? P r e B i r t h D i d y o u h a v e a c o n c r e t e b i r t h i ng p l a n? I f s o w h a t wa s i t ? W h o i f a n y o n e h e l p e d y o u c r ea t e y o ur b i r t h in g p l a n? W h o wa s y o ur p r im a r y t e a m o f p r o f e s s i o n a l s du r i ng y o ur p r e g n a n c y ? H o w d i d y o u p r e p a r e f o r l a b o r ? W h o h e l p e d y o u to p r e p a r e f o r l a b o r ? H o w w o u l d y o u d e s c r ib e y o ur e x p e r i e n c e o f b e i ng p r e g n a n t t h i s t im e ? H o w n e r v o us we r e y o u a b o ut g i v i ng b i r t h? D i d y o u v i s i t a t r a d i t i o n a l O B / GY N ? W e r e t h e y p r e s e n t du r in g y o ur b i r t h? B i r t h St o ry C a n y o u t e l l m e a b o ut y o ur b i r t h? D u r in g L a b o r W e r e y o u a b l e t o f o l l o w y o ur b i r t h i ng p l a n? I f n o t, w h y? I f y o u we r e ab l e t o f o l l o w i t h o w s a t i s f i e d we r e y o u w i t h y o ur p l a n i n ac t i o n? W h o wa s p r e s e n t du r in g t h e b i r t h? W e r e a ny p e o p l e p r e s e n t du r in g y o ur b i r t h t h a t y o u h a d n o t m e t b e f o r e g o in g in t o l a b o r ? D i d y o u f e e l a ny p r e s s u r e to d e v i a t e f r o m y o ur b i r t h i ng p l a n? D i d y o u f e e l a ny p r e s s u r e to r ec e iv e m e d i ca l in t e r v e n t i o n t h a t wa s n ot wa n t ed ? M i d w i f e Sp e c i f i c: W hy d i d y o u c h oo s e to u s e a mi d w i f e ? D i d y o u a n o t h e r k in d o f b i r t h i ng p r o f e s s i o n a l li ke a d o u l a ? H o w we l l d i d y o u k n o w y o ur mi d w i f e ( a n d/ o r

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72 d o ul a ?) D i d y o u f e e l a ny u n w a n t e d p r e ss u r e f r o m y o ur m id w i f e du r in g b i r t h i n g ? H o m e b i r t h Sp e c i f i c : W hy d i d y o u c h oo s e to g iv e b i r t h a t h o m e ? W h a t we r e t h e p a i n m a n a g e m e n t m e t h o ds u s e d du r i ng y o ur b i r t h? H o w wa s p a i n m a n a g e m e n t f o r y o u? H o w d o y o u u l t im a t e l y f e e l a b o ut y o ur c h o i c e t o g iv e b i r t h i n a h o m e e nv i r o n m e n t ? H o s p i t a l Sp e c i f i c : W hy d i d y o u c h oo s e to g iv e b i r t h i n a h o s p i t a l ? H o w we l l d i d y o u k n o w t h e d o c t o r w h o a s s i s t e d y o ur b i r t h? F o r h o w m u c h o f y o ur l a b o r we r e t h e y p r e s e n t ? W h a t we r e y o ur b i g g e s t f ea r s a ss o c i a t e d w i t h a h o s p i t a l b i r t h? W h a t a tt r ac t e d y o u to t h e h o s p i t a l e nv i r o n m e n t ? H o w l o n g d i d y o u s t a y a t t h e h o s p i t a l ? W h a t wa s t h e p a i n m a n a g e m e n t ? H o w d i d y o u f ee l a b o ut t h e p a i n m a n a g e m e n t y o u r ec e iv e d ? H o w d i d y o u u l t im a t e l y f e e l a b o ut y o ur c h o i c e t o gi ve b i r t h i n t h e h o s p i t a l e nv i r o n m e n t ? Power? Control? H o w d o y o u t hin k y o ur b i r t h w o u l d h a v e b e e n d i f f e r e n t i n a d i f f e r e n t s e t t i n g ? D o y o u r e g r e t a n y t h i ng a b o ut y o ur l a s t b i r t h? D i d y o u f ac e a n y n e g a t iv e r eac t i o ns b e ca u s e o f t h e s e t t in g o r w a y i n w h i c h y o u c h o s e to g i ve b i r t h? A ny qu e s t i o n s ? C o mm e n t s ?

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73 B I B L I OG RA P HY A n n a n d a l e E ll e n C 1988. H o w M i d w i v e s Acc o m p l i s h Na t u r a l B i r t h : M a n a g i ng R i s k a n d B a l a n c i ng E x p ec t a t i o n s So c ial Pr obl em s 35 ( 2 ) : 9 5 110 ( S t a b l e U R L : h tt p: / / www j s t o r o r g/ s t a b l e /800734 ) B a bb i e E a r l 2007. The Pr a c ti c e of So c i a l R e s e a r c h. 11 t h E d B e l m o n t C A : T h o m a s W a d s w o r t h B a k e r S a r a h R P r ec i a l l a Y L C h o i C a r o l A He n s h aw a n d J o a n n a T r ee 2005. I f e l t a s t h o ugh I d b e e n i n J a i l : W o m e n s E x p e r i e n c e s o f M a t e r n i t y C a r e du r in g L a b o u r De li v e r y a n d t h e I mm e d i a t e P o s t p a r t u m F em in i s m & P s y c holog y 15 ( 3 ) :315 34 2 ( D O I : 1 0 1177/0959 353505054718) B ec k e t t, K a t e r in 2005. C h oo s in g C e s a r e a n : F e min i s m a n d t h e p o l i t i c s o f c hi l d b i r t h in t h e U n i t e d S t a t e s F em ini s t Th e o r y 6 ( 3 ) :251 275 B ec k e t t, K a t h e r in e a n d B r i c e H o f f m a n 2005. C h a ll e n g i ng M e d i c i n e : L a w R e s i s t a n ce a n d t h e C u l t u r a l P o l i t i c s o f C h il d b i r t h L a w & S o c i e ty R ev i e w 39 ( 1) B e r g, M a r i e a n d A n n a T e r s t a n d. 2006. S we d i s h w o m e n s e x p e r i e n c e s o f d o u l a s upp o r t du r in g c hi l d b i r t h M id w i f e r y 22: 330 338. B li x, E ll e n 2011. A v o i d i ng d i s t u r b a n c e : mi d w i f e r y p r ac t i c e i n h o m e b i r t h s e tt in gs i n N o r wa y M i d w i f e r y 27 ( 5 ) : 687 69 2 C a h i l l Hea t h e r A 2001. M a l e a pp r o p r i a t i o n a n d m e d i c a l i za t i o n o f c hi l d b i r t h : a n h i s t o r i c a l a n a l y s i s J ou r nal of A d v an ce d N u rs ing 33 ( 3 ) : 33 4 342

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74 C a mm u, H G M a r t e n s G R u y s s i n c k, a n d J J A m y 2002. O u t c o m e a f t e r e l ec t iv e l a b o r in du c t i o n i n n u ll i p a r o us w o m e n : a m a t c h e d c o h o r t s t ud y A me r i c an J ou r nal of O b s t e t r i c s and Gy n ec olog y 18 6 ( 2 ) : 240 244 C a rr P a t r i c i a 19 9 2. L a b o ur R e l a t i o n s : M o t h e r s a n d H o s p i t a l P r o ce du r e I r i s h J ou r nal of So c iolog y 2 : 20 4 1. C a r t e r S h a n n o n K 2010. B e y o n d c o n t r o l : b od y a n d s e lf i n w o m e n s c h il d b e a r ing n a rr a t i v e s So c iol ogy of He alth & I lln e ss 32 ( 7 ) : 9 93 109. ( DO I : 1 0 1111/ j 1467 9566 2010 0126 1 x ) C h a i l l e t N il s E r i c D ub M a r yl n e D ug a s D i a n e F r a n c o e u r J o h a n n e D u b S o n i a Ga g n o n L u c i e P o i t r a s & A l e x a n d r e D u m o n t 20 0 8 I d e n t i f y i ng b a r r i e r s a n d f a c il i t a t o r s t o wa r d s i m p l e m e n t in g g u i d e l i n e s to r e du c e cae s a r ea n s ec t i o n r a t e s i n Q u e b ec B ull e tin o f the W o r ld He alth O r gani z ation ( h t t p : // www w h o in t / b u ll e t i n/ v o l u m e s /85/10/06 039289/ e n / ) C h e r v e n a k, F r a n k A L a u r e n c e B M c C u l l o u g h 2005. A n e t h i c a l c r i t i que o f b o u t i que f e t a l im a g i ng: A ca s e f o r t h e m e d i c a l i z a t i o n o f f e t a l i m a g i ng A me r i c an J ou r nal of O b s t e t r i c s and Gy n ec olog y 192:31 33 C h e y n e y M e ll i s a J 2008. H o m e b i r t h a s S y s t e m s C h a ll e n g i ng P r a x i s : K n ow l e dg e P o we r a n d I n t im a c y i n t h e B i r t h p l a ce Q ualitati v e He alth R e s e a r c h 18: 25 4 267 ( DO I :10 1177/104973230731239 3 ) C hi l d b i r t h C o n n ec t i o n 2012. R a t e s f o r T o t a l C e s a r ea n S ec t i o n P r im a r y C e s a r e a n S ec t i o n a n d Va g i n a l B i r t h A f t e r C e s a r e a n ( V B A C ) U n i t e d S t a t e s 198 9

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75 2010 ( h t t p:// www c h il d b i r t h c o nn ec t i o n o r g/pd f s / ce s a r e a n s ec t i o n t r e n d s p d f ) C h r i s t i a e n s W S. Va n D e V e l d e a n d P. B r ac k e 2011. P r e g n a n t w o m e n s f ea r o f c hi l d b i r t h i n m i d w i f e a n d o b s t e t r i c i a n l e d ca r e i n B e l g i u m a n d t h e Ne t h e r l a n d s : t e s t o f t h e m e d i c a l i za t i o n h y p o t h e s i s 51 ( 3 ) : 220 239 C o n r a d, P e t e r 199 2 M e d i c a l i za t i o n a n d S o c i a l C o n t r o l A nnual R ev i e w of So c iolog y 18: 209 232 C r a v e n C h r i s t i n a 2010. P u s hing f or M i d w i ve s : H o me bi r th M oth e r s and the R e p r odu c ti v e R ights M o veme nt. T e m p l e U n i v e r s i t y P r e ss Phi l a d e l p h i a P A to Hospi tal Birth in the United States, 1930 1960 The Birth and Family Journal 4(2):47 58 F o x B o n n i e a n d D i a n a W o r t s 1999. R e v i s i t i ng t h e C r i t i q u e o f M e d i c a l i ze d C hi l d b i r t h : A C o n t r ib u t i o n t o t h e S o c i o l og y o f B i r t h Ge nd e r and So c i e t y 1 3 ( 3 ) :326 346 Ge r b e r Su s a n E a n d A n t h o ny T L o S a ss o. 200 6 T h e e v o l v i ng g e n d e r g a p i n g e n e r a l o b s t e t r i c s a n d g y nec o l og y A me r i c an J ou r nal of O b s t e t r i c s and G y n ec olog y 195 ( 5 ) :1427 1430 G il k e y L a u r a 2009. S a r a s o t a M e m o r i a l ca n h e l p r e du c e h i g h C s ec t i o n r a t e s Sa r a s ota He r ald T r ibun e A p r i l 1. A cc e ss e d o n li n e : ( h t t p:// www h e r a l d t r ib u n e c o m / a r t i c l e /20090402/ C O L U M N I S T /904021039 )

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