Thesis advisor: Sharlene N. Hesse-Biber / Birth Visionaries: An Examination of Unassisted Childbirth By Lauren Ashley Brown Sharlene Nagy Hesse-Biber, Thesis Chair This exploratory study inquires into unassisted childbirth, the act of giving birth without the presence of any birth professional (doctor, midwife or doula). Unassisted birth is on the radical fringe of alternatives to the dominant techno-medical birth common in American hospitals today. My research questions are what are women's motivations for choosing unassisted childbirth and what is the lived experience of unassisted childbirth? I will answer these questions through nine in-depth interviews and a grounded theory data analysis. My approach comes from a focus on the everyday lived experience of women as problematic as well as insights from anthropology of birth and feminist postmodern sociology of knowledge. This study is relevant to public health policy on pregnancy and birth, to those working on questions of technology and culture, and to those concerned with how biosocial rituals shape embodied experience. My findings also contribute to research about power in contemporary society, specifically how the body can be a cite for social control and resistance. / Thesis (MA) — Boston College, 2009. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

This grounded theory study explored the experience of first-time fathers during the time of birth with the aim of developing a conceptual framework to explain how they managed the process. In sharp contrast to the recognised maternity care practices of a generation ago, most fathers in New Zealand are currently expected to be present when their babies are born. There has been little New Zealand-based research to determine what the birth experience is like for fathers. Because contemporary fathers are expected to fulfil a major role in the care and support of mother and baby from pregnancy through to new parenthood and beyond, exploring the experience of fathers during birth is a way to understand part of the childbirth process from the perspective of husbands or partners in the developing new family. Eleven first-time fathers from the North Island of New Zealand participated in antenatal and postnatal interviews that were conducted over a 20-month period. Transcripts were analysed using grounded theory processes of coding, constant comparative analysis and theoretical sampling, and a conceptual diagram was developed to explain the core process which was discovered, namely, 'being together and separate'. It emerged that fathers could feel separate from the birth process, together with the birth process and at times they could experience both positions concurrently. Influences on participants' experience of 'being together and separate' included social expectations, the level of control that participants wished to have during the birth and the ways in which fathers were drawn in or excluded by wives/partners and maternity caregivers. The ways in which maternity caregivers responded to the involvement of fathers in the birth process was found to have a significant impact on the participants' experience of the process. Implications for the practice of maternity caregivers and childbirth educators are the importance of assessing each father's needs antenatally and of assisting them to develop strategies for participating comfortably in the birth experience. The relevance of supporting fathers to participate in the childbirth process at a level that promotes positive birth outcomes for the entire expectant family is demonstrated, and some practical strategies are provided that can assist health professionals and others to support fathers.

It has been said that within a secondary care setting, surrounded by medical influences, it is difficult for midwives to keep birth normal. This qualitative study has been conducted to answer the question: "What are midwives' experiences of keeping birth normal within a secondary care setting?" van Manen's (1990) hermeneutic thematic analysis was the method used to analyse the data generated from this study. Eight "core" or hospital-based midwives were interviewed. The interviews were tape recorded and transcribed into text and were analysed to come to a deeper understanding of the research question. There are three data chapters that reveal the themes that emerged from the data: "Being a midwife 'is' keeping birth normal", "Stepping back and stepping in" and "Interacting with the doctor". The findings of the study revealed that seeing, knowing, and believing in normal birth leads to an embodied sense of "being" that infuses the way midwives practise. This knowledge needs to be passed on to junior midwives. Midwives judge when to use technology and intervention and the appropriate timing of intervention. The Relationships between medical practitioners and midwives is a key to keeping birth normal. Ultimately, it is through teamwork that normal birth is safeguarded. The midwives in this study demonstrate a quiet yet determined courage to constantly question the decisions that might take away from the "normal" experience. They do not say that intervention is not necessary, but question the appropriate use of intervention. This questioning keeps normal birth a possibility.

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 research situated antenatal education within a health promotion framework to determine a consumer-based approach to improving antenatal and postnatal education purported to prepare for parenthood. Research, both published and unpublished, criticises current structured educational programs and first time parents are reported to experience high levels of stress and unhappiness. Stage One of this study was a multiple source, multiple methods needs assessment conducted at two large, metropolitan hospitals in Sydney. The aim of the needs assessment was to explore the needs, interests and concerns of first time expectant and new parents, their changing nature during the childbearing year, ascertain learning processes that best suited their needs, and plan effective antenatal education around the results. Repeated in-depth interviews, focus groups, participant observation and surveys were used to collect data from expectant and new parents. Focus groups, surveys and participant observation were used to collect complementary data from educators, midwives and Child and Family Health Nurses who work with expectant and new parents. The third source of data analysed was documentary, that is program outlines and session plans of three comparable hospitals. The needs assessment demonstrated that to effectively prepare women and men for their childbearing experience, a range of strategies, programs and learning activities were required. This resulted in the design of a ‘menu’1 approach to antenatal and postnatal education with an emphasis placed on ‘life as a mum and a dad’, and the ‘world’ of their baby. The results also demonstrated a significant difference existed between the actual learning needs and priorities of expectant and new parents and those perceived to be their needs by the professionals. Expectant and new parents questioned the group facilitation skills of educators and identified methods to improve practice. Three strategies identified by these expectant and new parents as priorities were designed, implemented and an evaluation of each was undertaken in Stage Two of this study. The strategies were: 1. Seven session Having a Baby program for first time parents. 2. Group skills training program for antenatal and postnatal educators. 3. Breastfeeding resource package for antenatal educators. Stage Three of this research was an empirical study. A repeated measures randomised control trial was undertaken to test the effectiveness of the new Having a Baby program. In particular whether women and men who attended this program had improved perceived parenting self-efficacy, knowledge, and decreased worry about the baby eight weeks after birth compared with those who attended the conventional antenatal education program. The new program placed the labour and birth experience as a microcosm of the childbearing experience, and incorporated learning activities designed to enhance the confidence of pregnant women and their partners during their adjustment to parenthood. Perceived parenting self-efficacy2 was the measure by which parenting confidence, and therefore adjustment to parenthood, was measured The randomised control trial demonstrated that the perceived parenting self-efficacy of women and men in the experimental group was higher than those of control group participants at approximately eight weeks after the birth, with the difference being statically significant. The labour and birth outcomes of both groups, and their demographic details, were similar. Evaluation of the group skills training program for antenatal and postnatal educators and the breastfeeding resource package for antenatal educators were undertaken. Data collected from focus groups, interviews and surveys demonstrated the effectiveness of these strategies. The findings of this research question the validity of conventional antenatal classes and confirm the need for training and mentoring of antenatal educators. Effective, high quality antenatal education operating within budget allocation, facilitated by group skills trained educators, can produce superior postnatal outcomes.

The focus of this study is to understand why, despite high uptake of antenatal care, women in Uganda continue to deliver without skilled birth attendants. A critical gap in our knowledge is an understanding of the decisions women make during pregnancy and childbirth that determine the services they seek. Using a focused ethnography, we explored cultural knowledge and perceptions related to pregnancy and childbirth in Kabarole district. Interviews and focus group discussions were conducted with women that had recently given birth, their husbands/partners, biomedical and traditional health workers, and older women. HIV was identified as an important reason for seeking antenatal care. Other services used during pregnancy, biomedical and traditional, were accessed based on a complex array of beliefs and advice given to women. Thaddeus and Maines Three Delays Model provided a framework for analysis of barriers to skilled attendance at birth, which include distance, support from partners, and quality of health services.

As a woman with a spinal cord injury who uses a wheelchair, my thesis is an autoethnography that is based largely on the journals I have written in over the last twenty years, and in particular the journals I kept while I was pregnant and giving birth to my two children. Disability is a pervasive ideology that informs many of our cultural ideas of self and other, what constitutes acceptable and celebratory bodies, political stances, public policy, and language. Much of the literature that examines the female bodily experience excludes the stories and experiences of women with disabilities. Because the body with disabilities is often seen for what it can not do, taking on the role of mother can give the body a different value, status, and worth. I feel that my experiences as a woman with a disability experiencing pregnancy and childbirth offers insights and understanding into what it is already known about womens bodies. I display multiple levels of personal and cultural consciousness while connecting to the larger understandings of the culture of pregnancy, childbirth, and disability

As a woman with a spinal cord injury who uses a wheelchair, my thesis is an autoethnography that is based largely on the journals I have written in over the last twenty years, and in particular the journals I kept while I was pregnant and giving birth to my two children. Disability is a pervasive ideology that informs many of our cultural ideas of self and other, what constitutes acceptable and celebratory bodies, political stances, public policy, and language. Much of the literature that examines the female bodily experience excludes the stories and experiences of women with disabilities. Because the body with disabilities is often seen for what it can not do, taking on the role of mother can give the body a different value, status, and worth. I feel that my experiences as a woman with a disability experiencing pregnancy and childbirth offers insights and understanding into what it is already known about womens bodies. I display multiple levels of personal and cultural consciousness while connecting to the larger understandings of the culture of pregnancy, childbirth, and disability