Childbirth is an essential part of reproductive politics which have largely focused on expanding choice for women’s reproductive lives. Childbirth in the west has been medicalised, which means that authoritative knowledge was moved into the hands of the patriarchal medical establishment through displacement of traditional midwives, casting women as ‘hysterical’ and inherently sick and seeing birth as a medical event and technology as the appropriate way to deal with birth and the body. In the United States, with surveillance and risk factors, each woman in labour is considered in medical danger and treated accordingly, curtailing women’s ability to make decisions about their bodies and birth. The alternative or natural childbirth movement has resisted this form of medicalised birth, but within the movement, pressure can also be found on women to perform femininity and achieve a perfect birth. A focus on choice is therefore limited without also considering structural factors. / Graduate

This thesis sets out to explore some important gaps in the sociological and feminist understanding of the provision of maternity care and of women's health needs. The research was concerned with an exploration of the implementation of proposals for the provision of user-centred maternity care which emerged from the critiques of current medicalised provision. It evaluates the effects of an attempt to provide user-centred maternity care within the Primary Health Care sector (PHC) from both the women's and workers' perspectives and experience. The central questions addressed within the research have been: Firstly, to assess the degree to which such models of service delivery provide a user centred approach. Secondly, to identify the form of the relationship between the women users and providers from the practices and to develop an understanding of the mechanisms of interaction between them. Thirdly, to explore the extent to which the provision of such care is appropriate to match women users' self identified needs. Finally, to assess the potential of female health workers to adopt a form of provider and user relationship where the balance of power is altered in the users' favour. The main body of the research consisted of a qualitative study conducted in two general practices. These were chosen as specific examples of innovative practices attempting to provide a genuinely user-centred maternity service. The fieldwork consisted of three methodological components: Firstly, unstructured interviews were conducted with women users and workers. A sample of 30 women who were pregnant for the first time were interviewed on three occasions during their pregnancy and in the immediate post-natal period. In addition, 10 second time mothers were also interviewed post-natally. In terms of the workers', in depth interviews were conducted with midwives, GPs and practice nurses within the PHC setting. Secondly, observations were undertaken on the interactions between the women and workers and between members of the PHC team during the course of the women's antenatal and post-natal care. Finally, a structured questionnaire was used with a sample of women from one of the practice's well woman clinic. The research findings indicate the existence of a user-centred frame of reference held by female health workers - especially the midwives - for the provision of health care to women, which was opposed to the medical model. It explores the translation into practice of this model of maternity care and identifies the way that it functioned to enable women to exercise greater control over their health care and experience of pregnancy. Within this model the traditional 'with woman' role of the midwife was found to be central. Considerable convergence was found between the models held by the main parties in the interaction - issues concerned with choice, control and the provision of information were all found to be central to the care provided and to women's and workers' models. However, constraints on the effective implementation of the model were found in terms of the influence of professionalism (particularly on the GPs) and the dominance of the hospital system. These resulted in limits to the women workers' ability to meet the needs of women users.

Thesis (Ph. D.)--University of Washington, 1992. / Vita. Includes bibliographical references (leaves [168]-182).

Thesis (Ph. D.)--University of Washington, 1993. / Vita. Includes bibliographical references (leaves [132]-140).

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 115-133).

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 106-115).

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 152-165).

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [304]-327).

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 1997. / Typescript. Bibliography: leaves 116-125.

Thesis (Ph. D.)--University of Washington, 1992. / Vita. Includes bibliographical references (leaves [206]-221).