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Perceptions of Doula Support by Teen INFORMATION, KINSHIP, AND COMMUNITY: PERCEPTIONS OF DOULA SUPPORT BY TEEN MOTHERS THROUGH AN EVOLUTIONARY LENS by SHAYNA A. ROHWER A DISSERTATION Presented to the Department of Anthropology and the Graduate School ofthe University of Oregon in partial fulfillment of the requirements for the degree of Doctor ofPhilosophy September 2010 11 University of Oregon Graduate School Confirmation of Approval and Acceptance of Dissertation prepared by: Shayna Rohwer Title: "Information, Kinship, and Community: Perceptions ofDoula Support by Teen Mothers Through an Evolutionary Lens" This dissertation has been accepted and approved in partial fulfillment ofthe requirements for the Doctor ofPhilosophy degree in the Department ofAnthropology by: Lawrence Sugiyama, Chairperson, Anthropology Frances White, Member, Anthropology James Snodgrass, Member, Anthropology Melissa Cheyney, Member, Not from U of 0 John Orbell, Outside Member, Political Science and Richard Linton, Vice President for Research and Graduate Studies/Dean ofthe Graduate School for the University of Oregon. September 4,2010 Original approval signatures are on file with the Graduate School and the University of Oregon Libraries. 111 © 2010 Shayna Alexandra Rohwer IV An Abstract ofthe Dissertation of Shayna Alexandra Rohwer for the degree of Doctor ofPhilosophy in the Department ofAnthropology to be taken September 2010 Title: INFORMATION, KINSHIP, AND COMMUNITY: PERCEPTIONS OF DOULA SUPPORT BY TEEN MOTHERS THROUGH AN EVOLUTIONARY LENS Approved: Dr. Lawrence Sugiyama Human birth represents a complex interplay between our evolved biology and the cultural norms and expectations surrounding birth. This project considers both the evolutionary and cultural factors that impact the birth outcomes ofteen mothers that received support from a trained labor support person, or doula. Doula support has repeatedly been found to decrease the length of labor, the use ofpain medication, the rates ofcaesarian section, and instrumental births and to increase rates ofbreastfeeding and bonding. However, virtually no studies evaluate why these positive outcomes occur. Current life history models suggest that traits such as short inter-birth intervals, early weaning, extended dependency, and simultaneously raising multiple dependent offspring co-evolved with child-rearing support from multiple caregivers. These models suggest that mothers should be particularly sensitive to perceived cues ofsocial and material v support for childrearing; doulas might provide such cues. The goal ofthis project was to explore how doula support impacted teen mothers' perceptions oftheir birth experience and outcomes. Data for the project were drawn from three sources: a I5-month participant observation at a non-profit organization providing doula support to teen mothers, 20 semi-structured interviews with mothers who received doula support for the birth oftheir babies, and by my attendance as a doula at over 50 births. Results suggest that teen mothers experience upheavals in social relationships with their friends, families, and partners following the discovery oftheir pregnancy. Participants indicated that doula support increased their knowledge ofthe birth process, . provided unbiased and non-judgmental support and information, gave them confidence in their ability to give birth, and encouraged mothers to be proactive in communicating with their care providers. Teens used friendship and kinship terms when describing their doula, suggesting that doula support provides cues ofkinship that women have used throughout evolutionary history to assess the availability ofalloparental care. While doulas themselves provide salient cues ofsocial support, participants also indicated that doulas increased support from fathers and families, thus mobilizing support from existing social networks. Cues ofadequate support may lead to increased maternal investment, thereby improving both maternal and fetal outcomes. VI CURRICULUM VITAE NAME OF AUTHOR: Shayna Alexandra Rohwer GRADUATE AND UNDERGRADUATE SCHOOLS ATTENDED: University of Oregon University ofWashington Reed College DEGREES AWARDED: Doctor of Philosophy in Anthropology, 2010, University of Oregon Master of Arts in Biological Anthropology, 2004, University of Oregon Bachelor ofArts in Anthropology, 1998, University ofWashington AREAS OF SPECIAL INTEREST: Human reproduction, reproductive politics, human birth, doulas, midwifery, menarche, and menopause Male and female reproductive strategies, mate choice, life history theory PROFESSIONAL EXPERIENCE: Program Coordinator, Strength-in-Families Program, Juneau Family Health and Birth Center, Juneau, AK, January 2007-present. Teaching Assistant, Department ofAnthropology, University of Oregon, Eugene, OR,2002-2006. Undergraduate Adviser, General Sciences Program, University of Oregon, Eugene, OR, 2002-2004. Vll Archaeological Field Assistant, Katmai National Park, National Park Service, Katmai, AK, Summers of 2003 & 2004. Undergraduate Coordinator, Department of Anthropology, Universtity of Oregon, Eugene, OR, 2002-2003. Teaching Assistant, Department of Biology, University of Oregon, Eugene, OR, 2001. GRANTS, AWARDS AND HONORS: Youth Activities Grant, City & Borough of Juneau, 2009. Coastguard and Military Families Grant, United States Coast Guard, 2009. University of Oregon, Graduate School & Department of Anthropology, Research and Travel Grant, 2003. University of Oregon, Department of Cognitive and Decision Sciences, Research Award, 2003. Vlll ACKNOWLEDGMENTS This project would not have been possible without a great deal of information, kinship and community from a number of wonderful people. My advisor, Larry Sugiyama, has always come through for me, helping me realize both my strengths and shortcomings, while allowing me to follow what both interested and excited me. I am grateful to Frances White for her statistical expertise, mothering, and her guidance that kept me going when the going was most rough. To Josh Snodgrass, for being a steady wealth of information and support. To John Orbell for his insight and enthusiasm for all things with an evolutionary bent. And to Melissa Cheyney, my midwife and mentor, who introduced me to the world of birth, encouraged me to follow my passions, and who so beautifully balances all her different lives. Thank you all for your guidance and support. I also want to thank Iris Bicksler and Shea Hardy of Doulas Supporting Teens, for all their assistance and input with the project. Without their feedback, encouragement, and all the amazing work they do with teens, this project would never have been possible. I also am deeply indebted to Kaye Kanne, the director of the Juneau Family Health and Birth Center who gave me the space to continue working and learning while simultaneously finishing my dissertation. To my mom and dad who held my life together during the final weeks (and innumerable times before), with childcare, food, editing, and love. To my son, Reed Maier, who has so patiently endured his mother's absence for research and writing, and who has been an amazing teacher of mine in both birth and parenting. To my graduate school family, Jennifer Erickson, Nicholas Malone, Patrick IX Hayden, Melissa Baird, Carolyn Travers and Tami Hill: you all gave me support with this project and a sense of community that I'll treasure for the rest of my life. To the staff at the Juneau Family Health and Birth Center, for giving me space, support and experiences that have so profoundly impacted my understanding of the social landscape of pregnancy and birth. And finally my husband, Kevin Maier, who has so patiently endured the wild ups and downs of this process with unfailing amounts of love and support. x This dissertation is dedicated to all the amazing teen mothers who shared their stories, births, and insights with me. Xl TABLE OF CONTENTS Chapter Page I. INTRODUCTION 1 Project Overview............................................................................................... 1 Theoretical Orientation................................................................................ 2 Research Questions...................................................................................... 5 Dissertation Overview....................................................................................... 6 II. EVOLUTIONARY LIFE HISTORY THEORY AND THE OBSTETRICAL DILEMMA............................................................................................................. 9 Life History Theory........................................................................................... 9 Human Life History Patterns 10 Extraordinary Cognitive Abilities and the Costly Human Brain 11 Why Such Divergent Life History Patterns? Practice, Learning, Grandmothers and Cooperative Breeding................................................... 15 Cooperative Breeding 19 An Evolutionary Approach to Birth 21 Maternal Investment.......................................................................................... 28 Postpartum Depression 33 Evolutionarily Relevant Cues of Experienced Support and the Alloparental Environment 36 III. THE DILEMMA OF MATERNAL INVESTMENT: TEEN REPRODUCTIVE DECISIONS................ 39 Timing of Reproductive Readiness and Other Correlates of Teen Pregnancy..... 39 Age of Menarche 39 Teen Pregnancy in Cross-Cultural Context 47 Teen Pregnancy in a Modern US Context 48 Why Is Teenage Pregnancy Associated with Adverse Outcomes? 50 Doula Support and the Social Risks of Teen Pregnancy.. 53
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