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Factors Associated with Health Care Access for Ohio Mothers Who Chose Home Birth

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Factors Associated with Health Care Access for Ohio Mothers Who Chose Home Birth Factors Associated with Health Care Access for Ohio Mothers who Chose Home Birth THESIS Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Martha Catherine Nieset Graduate Program in Rural Sociology The Ohio State University 2013 Master's Examination Committee: Professor Joseph Donnermeyer, Advisor Professor Cathy Rakowski Copyrighted by Martha Catherine Nieset 2013 Abstract Every year in Ohio and throughout the United States women of childbearing age are increasingly making the decision to forgo the hospital setting and give birth at home. The evidence has shown that women’s decisions to birth at home are highly influenced by their desire for greater control over their birth process in order to avoid unnecessary, technology-intensive interventions in the normal birth process. The body of research has demonstrated similar safety ratings for both the mother and child in planned low-risk home and hospital births attended by skilled providers. Compared with low-risk hospital births, outcomes of intended home births have consistently shown considerably lower rates of medical intervention in episiotomy, electronic fetal monitoring, caesarean section, and vacuum extraction with home birth care providers receiving higher client satisfaction ratings than their in-hospital counterparts. Currently over half of U.S. states regulate home birth midwife practice (most commonly the Certified Professional Midwife, CPM) through some form of licensure or statute. Ohio currently does not regulate the practice, leaving women seeking a midwife for a home birth without a legally recognized care provider. Recognizing home birth as an option, tracking down a home birth midwife, and going through an entire pregnancy planning a home birth are not highly visible options for the majority of women in part because of the uncertainty ii around home midwifery practice and the potential for it to be construed as “practicing medicine without a license” and prosecuted as such. Though prosecution is infrequent in Ohio, most midwives practice with caution, receiving clients by word of mouth and association rather than advertising online or from a public business model. Beyond the fact that we know home birth is happening in Ohio and that it is increasing at a high rate, very little has been demonstrated in the research about how women find their midwives and their experiences with that care. This research was carried out using an online, anonymous survey distributed through social media and email community lists. Surveys sought participation from Ohio mothers who had planned a home birth for their child in the previous 5 year time period. The results yielded participation by 365 women, an estimated 10% of the potential sample size. While demographically the sample was similar to prior studies of U.S. home birth populations, new information and characteristics of the population and their choices were revealed. The results of the study painted a picture of women planning and seeking home birth, somewhat contrary to the risk-taking, anti-doctor, technology-averse, picture of which home birthing women are typically painted in American popular culture. A majority of the women who planned home births were highly educated, concerned with safety, sought a backup or collaborative healthcare physician, and participated in ultrasound testing. Other findings revealed the difficulties the women faced in obtaining an appropriate care provider: traveling longer distances to receive care, few care provider options, paying fees out of iii pocket, and hiring midwives later in their pregnancy. The results of the study indicate the need for policy in Ohio to improve access to qualified home birth health care providers. iv Acknowledgments I would like to personally thank all those who have supported me along the way in my graduate work and for this thesis in particular. It has been a long journey and would not be coming to completion without the support of many good people. Thank you most of all to my advisor Joe Donnermeyer, the countless hours you’ve spent meeting with me reading and discussing the research has been a major support for me in this step by step process. Thank you for your time and patience and most of all your encouragement. Next I’d like to thank my family members, friends, and colleagues who have also been a major source of encouragement for me. I couldn’t have done it without you. Thank you also to Cathy Rakowski my committee member and teacher for your suggestions, the program coordinators in the School of Environment and Natural Resources, and The Ohio State University for your direction and the opportunity. v Vita May 1993 .......................................................St. Joseph Central Catholic High School 1998................................................................B.A. Psychology, Bowling Green State University 2000 to 2003 ..................................................Software Administrator, Center for Information Services 2003 to 2013 ..................................................Information Analyst, College of Arts and Sciences, The Ohio State University 2013 to present……………………………….Enrollment Analyst, Office of Institutional Effectiveness, Columbus State Community College Fields of Study Major Field: Rural Sociology vi Table of Contents Abstract ............................................................................................................................... ii Acknowledgments............................................................................................................... v Vita ..................................................................................................................................... vi List of Tables ..................................................................................................................... xi List of Figures ................................................................................................................ xviii Chapter 1: Introduction ....................................................................................................... 1 Purpose of Study ............................................................................................................. 2 Research Objectives ........................................................................................................ 4 Significance of Study ...................................................................................................... 5 Chapter 2 - Literature Review and Study Framework ........................................................ 8 Home Birth Safety ........................................................................................................... 9 Home Birth Choice........................................................................................................ 15 Researching Accessibility ............................................................................................. 18 Health Policy ............................................................................................................. 18 vii Characteristics of the Health Delivery System .......................................................... 21 Utilization of Health Services .................................................................................... 22 Characteristics of the Population at Risk ................................................................... 22 Consumer Satisfaction ............................................................................................... 22 The following is a short glossary of terms used throughout this thesis. ....................... 23 Chapter 3 - Methods.......................................................................................................... 27 Research Design ............................................................................................................ 27 Subject Selection ........................................................................................................... 29 Instrument Construction ................................................................................................ 30 Data Collection .............................................................................................................. 31 Process and Timeline for Data Collection..................................................................... 31 Sample Limitations .................................................................................................... 41 Chapter 4 – Results ........................................................................................................... 43 Reasons for Home Birth ................................................................................................ 43 Characteristics of the Population................................................................................... 51 Characteristics of the Health Delivery System ............................................................. 58 Utilization of Health Services ....................................................................................... 68 Consumer Satisfaction................................................................................................... 79 viii Data Analysis ................................................................................................................ 80 Age............................................................................................................................
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