Claremont Colleges Scholarship @ Claremont Pitzer Senior Theses Pitzer Student Scholarship 2014 A Mother's Paradox: Choosing a Birthing Method in the 21st Century Jenae Franklin Pitzer College Recommended Citation Franklin, Jenae, "A Mother's Paradox: Choosing a Birthing Method in the 21st Century" (2014). Pitzer Senior Theses. Paper 57. http://scholarship.claremont.edu/pitzer_theses/57 This Open Access Senior Thesis is brought to you for free and open access by the Pitzer Student Scholarship at Scholarship @ Claremont. It has been accepted for inclusion in Pitzer Senior Theses by an authorized administrator of Scholarship @ Claremont. For more information, please contact [email protected]. A MOTHER’S PARADOX: CHOOSING A BIRTHING METHOD IN THE 21ST CENTURY by Jenae Franklin A THESIS SUBMITTED TO PITZER COLLEGE IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE HUMAN BIOLOGY MAJOR CLAREMONT, CALIFORNIA May, 2014 © Jenae Franklin, 2014 The undersigned certify that they have read, and recommend for acceptance, a thesis entitled “A Mother’s Paradox: Choosing a Birthing Method in the 21st Century” submitted by Jenae Franklin in partial fulfillment of the requirements for the Human Biology Major ________________________________________________ Supervisor, (Lêda Martins, Anthropology) ________________________________________________ Second Reader (Fred Lynch, Government) ________________________________________________ Third Reader (Dan Segal, Anthropology) ______________________ Date ii Abstract Investigating childbirth, one of the biggest moments of a woman’s life, this thesis examines the reasons behind women’s preferred birthing methods. This research explores the fundamental decisions women make during the birthing process: the amount of prenatal care mothers will receive, the type of health care provider they will use, picking the place of delivery, views on technological and medical interventions, and outlooks on natural childbirth. In addition to an extensive literature review, in-depth interviews with mothers, midwives, and obstetricians are used to examine the various controversies of childbirth. This thesis begins with a review of the transition from midwives to physicians as customary birth attendants in the United States and offers a comparison to obstetric care in Europe. Then comparing the training of obstetricians and midwives and their birthing philosophies to examine the medical and holistic models of childbirth. Finally, first-hand experiences of mothers conclude the research conducted and offer insight on the controversies of childbirth in an age of medical and technological interventions. This research concludes that the transitions in American history have led to the cultural norm of medicalized, hospital births attended by physicians. These societal customs have led to great ambivalence towards alternative methods of childbirth such as not using the medical and technological resources available or using a midwife. With this, there has been a paradox created between the institutional pressures of childbirth and an individual’s choice when deciding what will be involved in a woman’s childbirth experience. iii Acknowledgements I would like to thank Professor Lêda Martins for her dedication and support over the last four years. My gratitude to Professor Martins goes beyond the work she contributed to my thesis but years worth of academic and life advice that I will cherish far past my time at Pitzer. I would also like to thank Professor Dan Segal and Professor Fred Lynch for their help during the year while writing this thesis. Additionally, I would like to thank Kristin Sitcov for her assistance during my research, without her I would not have known where to start. Lastly, I would like to thank my friends and family for all of their continued support. iv Table of Contents Abstract…….................................................................................................................................. ii Acknowledgements....................................................................................................................... iii Table of Contents.......................................................................................................................... iv INTRODUCTION ...........................................................................................................................1 Why is this Research Important? .........................................................................................2 Methods, Ethics, Limitations ...............................................................................................4 Theoretical Framework........................................................................................................8 Summaries of Chapters......................................................................................................10 Conclusion .........................................................................................................................12 CHAPTER ONE: Contextualizing the Problem............................................................................13 Introduction........................................................................................................................13 The History of Obstetric Care............................................................................................13 The Rise of The Nurse-Midwife........................................................................................18 Obstetric Care Today .........................................................................................................20 Compared to Europe ..........................................................................................................28 Conclusion .........................................................................................................................35 CHAPTER TWO: Obstetricians and Midwives ............................................................................37 Introduction........................................................................................................................37 Training..............................................................................................................................37 The Medical Model versus The Holistic Model ................................................................40 Prenatal Care......................................................................................................................48 Medical and Technological Interventions..........................................................................50 The Future of Obstetric Care .............................................................................................56 Conclusion .........................................................................................................................58 CHAPTER THREE: A Mother’s Decisions..................................................................................60 Introduction........................................................................................................................60 Prenatal Care......................................................................................................................60 Choosing a Health Care Provider ......................................................................................65 Transitions in American Culture........................................................................................70 Technology’s Influence on the Natural Process ................................................................73 v Choosing the Right Method...............................................................................................76 Conclusion .........................................................................................................................78 CONCLUSION..............................................................................................................................80 BIBLIOGRAPHY..........................................................................................................................87 1 Introduction As a Human Biology undergraduate student I do not have any first-hand experience with childbirth, but I have a passion for learning about the human experience, medicine, health care, and the way the body works. My curiosity is where my interest in childbirth begun. My interests in health care steered me to an internship position at the Foundation of Health Care Quality, a nationally recognized non-profit organization working to reduce variations in outcomes and improving the quality of care for patients in the state of Washington. The division I was placed in was the Obstetrics Clinical Outcomes Assessment Program (OBCOAP). OBCOAP uses provider-specific, chart-abstracted data about the care given to women during labor, delivery and the postpartum period as the basis for analysis and discussion. Outcomes for newborns as well as moms are also part of the discussion. These data are analyzed to evaluate labor management practices and interventions commonly used in labor and delivery and compare implications of care decisions, allowing for opportunities to explore methods for actionable and sustainable improvements. My experience at OBCOAP led me to explore the decisions that mothers make during the childbirth process. Is it possible that outcomes could be improved from the very beginning, starting with the decisions