Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 243-262).

Thesis--University of Kansas. / Includes bibliographical references (leaves 122-129).

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Thesis (MMidwif)--University of South Australia, 2001

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’.

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 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.