Low-income women in an Oregon city of approximately 35,000 inhabitants have
limited access to prenatal care services during their pregnancies. The purpose of this study
was to uncover the impacts of several factors on the experiences of twenty-seven health
department clients with public health department prenatal care practitioners and with local
private obstetricians. Ethnographic interviews were conducted with the clients, two health
department practitioners, two local obstetricians, and one local direct-entry midwife. The
focal finding that emerged from the research was that the clients preferred the care of the
health department practitioners to that of obstetricians, even though the health department
providers could not deliver the women's babies.
The major impacts on the clients' experiences included fragmented service delivery
and availability, economic and social restrictions on prenatal care options, biomedical
constructs of a healthy pregnancy, and provider role constructions and attitudes towards
Medicaid recipients and uninsured pregnant women. Local physicians' mechanistic
philosophy, professional dominance and profit orientation afforded them a narrow
understanding of the needs and identities of low-income women. Local public health
workers are less professionally autonomous than medical doctors but their service
orientation allowed them the potential to better serve low-income clients.
Based on the twenty-seven clients' perceptions of their care providers and the
services available to them, recommendations are made for more empowering,
comprehensive prenatal care services in this county. Recommended changes to the public
health system entail expanded funding for more appropriate programs and to establish
continuity of care for health department clients from pregnancy through the postpartum
period. The incorporation of direct-entry midwives into the prenatal and birthing care
options open to low-income women is also recommended. Senate Bill 1063, which creates
a process for direct-entry midwives to become state-licensed in order to be reimbursed by
the Office of Medical Assistance Programs for perinatal services, is considered in terms of
its implications for low-income women, the Oregon community of direct-entry midwives,
and the texture of Oregon reproductive health care. / Graduation date: 1994
| Identifer | oai:union.ndltd.org:ORGSU/oai:ir.library.oregonstate.edu:1957/28359 |
| Date | 19 October 1993 |
| Creators | Pearce, Laurie Kathleen |
| Contributors | Rosenberger, Nancy |
| Source Sets | Oregon State University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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