This thesis presents the findings of a doctoral study which analysed video tapes of labouring Australian women at the end of the 20th century, historical data from midwifery and medical textbooks, consumer material, and personal experience as a midwifery student in 1970- 1971. The data analysis was achieved using discourse analysis, but was influenced by Michel Foucault together with anthropological and sociological approaches, particularly as these can be applied to visual material. ‘Dirt’ is a commonly accepted term, but it becomes difficult to define as it is so dependant on the context. Since the discovery of the germ theory in the 19th century, however, it is difficult for western health professionals to conceive of dirt as being anything but unaesthetic, unhygienic and pathogenic. When analysing the data from this study, it became evident that birth and dirt have a close association. The changes that have occurred in childbirth have revolved around who and what is perceived as clean, and who and what is perceived as dirty. This thesis argues that ‘birth dirt’ exists, but, its form will vary depending on the time, the place, and the culture, although it is always centred around the physical reality of birth. Video tapes of the birthing process indicate that midwives, in their ritualised behaviours of containing, controlling and cleaning up the ‘dirt’ associated with birth, create a barrier between themselves and the women. ‘Dirt’ in this instance is the ‘contaminating’ body fluids and substances derived from the woman and her baby. The dirt relationship is a power relationship and the midwife is an essential part of its structure. The midwife is the dirty worker who maintains the cleanliness of the environment and controls the ‘dirt’ during birth. There is considerable rhetoric about midwives as being ‘with woman’, but the reality is that the midwives are more often ‘with dirt’.

This thesis presents the findings of a doctoral study which analysed video tapes of labouring Australian women at the end of the 20th century, historical data from midwifery and medical textbooks, consumer material, and personal experience as a midwifery student in 1970- 1971. The data analysis was achieved using discourse analysis, but was influenced by Michel Foucault together with anthropological and sociological approaches, particularly as these can be applied to visual material. ‘Dirt’ is a commonly accepted term, but it becomes difficult to define as it is so dependant on the context. Since the discovery of the germ theory in the 19th century, however, it is difficult for western health professionals to conceive of dirt as being anything but unaesthetic, unhygienic and pathogenic. When analysing the data from this study, it became evident that birth and dirt have a close association. The changes that have occurred in childbirth have revolved around who and what is perceived as clean, and who and what is perceived as dirty. This thesis argues that ‘birth dirt’ exists, but, its form will vary depending on the time, the place, and the culture, although it is always centred around the physical reality of birth. Video tapes of the birthing process indicate that midwives, in their ritualised behaviours of containing, controlling and cleaning up the ‘dirt’ associated with birth, create a barrier between themselves and the women. ‘Dirt’ in this instance is the ‘contaminating’ body fluids and substances derived from the woman and her baby. The dirt relationship is a power relationship and the midwife is an essential part of its structure. The midwife is the dirty worker who maintains the cleanliness of the environment and controls the ‘dirt’ during birth. There is considerable rhetoric about midwives as being ‘with woman’, but the reality is that the midwives are more often ‘with dirt’.

States continually swing like a pendulum, changing their momentum from home birth, to institutionalized births. Prior to the twentieth century, most births occurred in the home setting and were viewed as a normal process. Today, home births only account for 1 % of the births in North America (Wong & Perry, 1998). With the increased dependency on medical professionals in this century, childbirth has become a medical process rather than a natural event. As healthcare consumers strive for greater control of their care, many women are choosing to give birth at home or in birthing centers, in environments in which they have control. The greatest concern that women face is the safety of their choice for both themselves and their unborn child. The purpose of this study was to compare maternal and perinatal outcomes of selected birthing methods. The methodology utilized was a literature review and synthesis, which includes publications from nursing, medical and related fields from 1990-2002. Birthing methods are defined, compared and contrasted based on outcome measures, and the safety and efficacy of each examined. This information will be used as a basis for recommendations for current practice, nursing education, and further research.

Typescript. Includes vita and abstract. Includes bibliographical references (leaves 153-156). Also available online.

Thesis (Ph. D. in Psychology)--Vanderbilt University, Dec. 2005. / Title from title screen. Includes bibliographical references.

The objectives of this study were to determine whether there was an association between clinical nursing knowledge of four birthing positions and current evidence-based research of those same positions and also to identify possible areas where nursing knowledge of those birthing positions was inadequate. This pilot study used convenience sampling to survey registered nurses (RNs) and licensed practical nurses (LPNs) on labor and delivery units. The survey was distributed to three hospitals in the southeastern United States, and twenty-four RNs and LPNs participated. Participants’ knowledge did not reflect current clinical evidence in two key areas, (1) the best position to minimize blood loss and (2) the best position to decrease the likelihood anal sphincter tears. Respectively, only 13% and 27.3% of participants selected the correct position. Continuing education for maternity nurses regarding current evidence-based practice concerning various birthing positions remains a need, and incorporating this could include more frequent opportunities for education classes and unit inservices. Results from this study should not be generalized, and more research is needed in this area to validate these findings.

Haiti is a Caribbean island with a humanitarian medical center providing healthcare services to 90,000 residents. Pregnant women visiting the medical clinic for prenatal care often do not return for delivery; instead, they return home to deliver alone or with the assistance of a traditional matron. Home-birth practices increase maternal-child health morbidity and mortality in an already fragile country. The purpose of this project was to gain a deeper understanding of Haitian pregnant women's preferences to deliver at home or at the healthcare clinic. The transtheoretical model for behavior change and the Johns Hopkins nursing evidence-based practice model guided the project. Two focus groups of 10 pregnant women total were recruited in the community of Delmas 32, Haiti. Group 1 was comprised of 5 women who delivered at home with matrons and Group 2 was comprised of 5 women who delivered at the clinic. Structured questions were asked to identify themes related to delivery location preferences. Focus group transcripts were analyzed guided by the Krueger and Casey strategy model. The thematic analysis was aligned with the peer-reviewed literature. Findings revealed that lack of access to care, lack of education and sensitization, and the attitude of healthcare personnel impacted women's preference for delivery at the clinic. Findings also supported a need to educate staff and the community in the best options for maternal-child care. A workshop was developed, based on the project findings, to share the recommendations with the clinic staff. The clinical leadership have indicated that they will implement the project recommendations. This project has the potential to support social change by reducing maternal-child deaths in Delmas 32 and across the Caribbean.

Numbers of caesarean sections, epidurals, and other forms of medical interventions for birthing are rising in the United States healthcare industry. One possible reason is the medicalization of birthing and labor techniques. Another potential reason is the increasing distinction between laboring in a hospital versus laboring in the home or an independent birthing center. The dominance of the medical model of birthing has led to social constructions of birthing that divide women by diagnosis, into either high-risk or low-risk prenatal categories, further perpetuating the medical model’s power to marginalize the midwifery model. Forty percent of U.S. births are financed by Medicaid insurance. Because Medicaid insurance is based on the technocratic medical model, birthing providers that accept Medicaid insurance may be pressured, directly and indirectly, to adopt the medical model as the most appropriate birthing option, decentering the midwifery model. Inevitably, this potentially shifts birthing options and experiences for low-income women in the U.S. In order to understand how low-income women experience birthing in U.S birthing institutions, we first need to take a closer look at how birthing facilities socially construct birthing. Among many areas of influence for the social construction of birthing, website content has been neglected as a form of primary data. Using content analysis, this study investigates how web content aids in the social stock of knowledge on labor and delivery. Analyzing the websites of three birthing centers and two public hospitals that accept Medicaid insurance in Miami, Florida, this study’s findings indicate that the language used on birthing center websites aligns with the midwifery model, but reverts to the medical model used by hospitals, in language and policy, when discussing cases of emergency birthing. The public hospital websites, meanwhile, appropriate the language and procedures of the midwifery model without providing the practical benefits of natural birthing. Findings in this study also capture a snapshot of birthing models used by providers in Miami, Florida ahead of its 2016 transition from the Florida Medicaid system to the Federally-Funded Marketplace, as per the Affordable Care Act of 2009. By assessing how birthing providers socially construct birthing, we could reduce the underrepresentation of natural birthing, exposing low-income women to more balanced depictions of both the medical and midwifery models of birthing, possibly reducing negative socio-emotional outcomes during birthing, postpartum depression and maternity-mortality rates among the poor.

This study examines the traditional views surrounding Indigenous birthing and mothering, as well as the mother-child relationship cycle in contemporary Indigenous literature, and compares the traditional past to the contemporary present. Five contemporary Indigenous novels from four different American Indian and Indigenous Nations are included: Louise Erdrich's The Painted Drum (Ojibwe), Betty Louise Bell's Faces in the Moon (Cherokee), Dawn Karima Pettigrew's The Way We Make Sense and The Marriage of Saints (Creek), and Alan Duff's Once Were Warriors (Maori). Themes in the novels are studied individually and collectively, through the frameworks for literary analysis that Arnold Krupat terms nationalism, indigenism, and cosmopolitanism. Each novel will be analyzed first using Arnold Krupat's theory of literary nationalism, which suggests that in order to fully comprehend an Indigenous text, it must be explored using only a culturally-specific framework that focuses specifically on the Nation depicted within the novel. However, on a broader scope Krupat's literary theory of indigenism will addressed throughout this study, examining ways in which similar parallels within each selected text and Nation overlap to create common areas of study. Lastly, aspects of the mother-child relationship will be assessed using Krupat's theory of literary cosmopolitanism, which suggests that even though there are very unique aspects of Indigenous literature that must be viewed from a tribally-specific vantage point, there are also cosmopolitan, or common, elements within the human experience that link all individuals together like the act of birthing and mothering.

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