TRUST AND TRANSFORMATION: WOMEN’S EXPERIENCES CHOOSING MIDWIFERY AND HOME BIRTH IN ONTARIO, CANADA by Shawna Healey DiFilippo A thesis submitted in conformity with the requirements for the degree of Master of Arts Department of Leadership, Higher and Adult Education University of Toronto © Copyright by Shawna Healey DiFilippo 2014 TRUST AND TRANSFORMATION: WOMEN’S EXPERIENCES CHOOSING MIDWIFERY AND HOME BIRTH IN ONTARIO, CANADA Shawna Healey DiFilippo Master of Arts Department of Leadership, Higher and Adult Education University of Toronto 2014 Abstract Using a critical feminist approach, and with attention to participants’ broad life experiences, this qualitative study explores seven women’s challenging, transformative decisions to give birth at home with midwives in Ontario, Canada. To make this choice, the women had to draw on their own strength, take responsibility for their decisions, and resist the dominant view of birth as inherently risky, and of women’s birth experiences as unimportant and incompatible with more narrowly defined good outcomes. As participants became informed decision-makers, resisted medicalized birth, and envisioned more woman-centred possibilities, they were empowered as active agents in their births. They were able to trust that with the care of their midwives, and the support of their partners or close family, they could have satisfying and safe births at home. ii Acknowledgments My sincere thanks to: the women who volunteered for this study, for welcoming me into their homes and workplaces, and for sharing their time and personal experiences with me; midwifery practices and their clients for allowing me to attend their prenatal classes and home birth information nights; my thesis supervisor and professor, Dr. Angela Miles, for her expertise and guidance at all phases of my research; and Dr. Mary Sharpe, director of the Ontario Midwifery Education Program at Ryerson University, for generously sharing her time, insights, and enthusiasm. I also thank: Christine Santos, for being a willing interview “test case”; Florence and Gino DiFilippo, for their many hours of childcare, without which I would not have completed this project; and Kathy and David Healey, for their support, and for instilling in me a desire to question the rules when they seem unfair. Lastly, I express my gratitude to my partner Gianni, for his love, and for his patience and encouragement in this project and in everything I do. iii Table of Contents Abstract ......................................................................................................................................................................... ii Acknowledgments ........................................................................................................................................................ iii Table of Contents ......................................................................................................................................................... iv PREFACE .................................................................................................................................................................... 1 BACKGROUND .......................................................................................................................................................... 2 Chapter 1: Introduction ........................................................................................................................................ 2 Childbirth in Ontario: The Personal is Political .................................................................................................. 2 Study Rationale................................................................................................................................................... 5 Midwifery and Home Birth in Ontario ............................................................................................................... 8 Historical Overview ....................................................................................................................................... 8 The Midwifery Model of Care in Ontario......................................................................................................... 10 Chapter 2: Literature .......................................................................................................................................... 13 The Medical Model of Childbirth and its Implications for Childbearing Women ............................................ 13 Authoritative Knowledge and Childbirth.......................................................................................................... 16 Scientific Evidence about the Safety of Planned Home Birth for Low-Risk Pregnancies ................................ 17 Women’s Satisfaction with Midwife-Attended Home Birth ............................................................................ 22 Women’s Motivations for Choosing Midwife-Attended Home Birth .............................................................. 23 Chapter 3: Methodology ...................................................................................................................................... 28 Why a Qualitative Approach?........................................................................................................................... 28 Locating Myself in the Research Project .......................................................................................................... 28 Critical Feminism as a Theoretical Framework ................................................................................................ 30 Narrative Inquiry and Life History Research .................................................................................................... 32 Methods ............................................................................................................................................................ 34 Data Collection ............................................................................................................................................ 34 Participant Recruitment ............................................................................................................................... 35 Participant Biographical Sketches ............................................................................................................... 36 Analysis ....................................................................................................................................................... 39 Ethical Considerations ...................................................................................................................................... 40 FINDINGS ................................................................................................................................................................. 43 Introduction and Overall Analysis ......................................................................................................................... 43 Overall Frame ................................................................................................................................................... 43 Decision-Making Context ................................................................................................................................. 43 Central Finding ................................................................................................................................................. 44 Findings Overview ........................................................................................................................................... 45 PART ONE ........................................................................................................................................................... 48 Chapter 4: Unlearning ......................................................................................................................................... 49 Interrogating Myths and Misconceptions about Contemporary Midwifery and Home Birth in Ontario .............................................................................................................................................................. 50 Questioning Unconditional Trust in Western Medicine: Women and their Partners Learn Together ............................................................................................................................................................ 53 Redefining Authoritative Knowledge about Childbirth: Experience and Intuition .......................................... 55 iv Mary-Beth: Honouring the Wisdom of Mothers ......................................................................................... 60 Discussion ................................................................................................................................................... 65 Chapter 5: Relearning ......................................................................................................................................... 68 Doing Your Homework .................................................................................................................................... 68 Insights from Holistic Childbirth Advice Books .............................................................................................. 69 Empirical Quantitative Studies about Home Birth Safety ...............................................................................