University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School April 2021 Listening to Women: Using a Mixed-Methods Approach to Understanding Women’s Desires and Experience During Childbirth Nicole Loraine Falk Smith University of South Florida Follow this and additional works at: https://scholarcommons.usf.edu/etd Part of the Biological and Chemical Physics Commons Scholar Commons Citation Falk Smith, Nicole Loraine, "Listening to Women: Using a Mixed-Methods Approach to Understanding Women’s Desires and Experience During Childbirth" (2021). Graduate Theses and Dissertations. https://scholarcommons.usf.edu/etd/8768 This Dissertation is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. Listening to Women: Using a Mixed-Methods Approach to Understanding Women’s Desires and Experience During Childbirth by Nicole Loraine Falk Smith A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Anthropology College of Arts and Sciences University of South Florida Major Professor: Lorena Madrigal, Ph.D. David A. Himmelgreen, Ph.D. Elizabeth M. Miller, Ph.D. Linda A. Detman, Ph.D. Wenda R. Trevathan, Ph.D. Date of Approval March 11, 2021 Keywords: Homebirth, Physiological Normal Birth, Evolutionary Medicine, Cortisol, Obligate Midwifery Copyright © 2021, Nicole Loraine Falk Smith DEDICATION In loving memory of my Mother, Linda, a free spirit. When I struggled, she would tell me that we were pebbles in a stream. That sometimes we’d get caught in a little whirlpool and we would stay awhile. Eventually, the current would carry us on, so don’t fight the current, she’d say, let it take you where you belong. ACKNOWLEDGMENTS I am so thankful to all the people who supported me in this endeavor and those who continued to encourage me on my worst of days. First, I want to thank the mothers and the midwives who participated in this study. Truly, the best part of conducting this research was talking to you. I enjoyed meeting you, especially those who invited me into their homes and let me hold their new born babies. Next, I want to thank Lorena Madrigal. Lorena has been a role model and an inspiration to me since I first met her almost 20 years ago. It is an honor to earn my PhD with you as my major professor. I also want to thank my committee members, David, Elizabeth, Linda, and Wenda. Thank you for your support, patience, and insight. I want to thank my father, Duane. Down every path I have taken, he has always been there for me. He has probably read more of my writing than anyone else. When I took my first college class and received a B, he said “always ‘B’ yourself.” I still live by those simple words. My mom, who I dedicated this work to, was an amazing woman. I miss talking to her dearly. When I was a girl, I struggled to read due to dyslexia, but with a mother’s love, I persisted. My dearest friends, Sara, Leslie, Janet, Etel, and Kimberly, thank you for your friendship. We have seen each other through a lot and I couldn’t have made it through without you. Finally, I thank my daughter, Dwana. You are a blessing beyond all blessings to me. You are wise beyond your years. Thank you for your understanding and encouragement as I worked through this writing process. TABLE OF CONTENTS List of Tables ................................................................................................................................. iii List of Figures ................................................................................................................................ iv Abstract ............................................................................................................................................v Chapter One: Introduction ...............................................................................................................1 Chapter Two: Literature Review .....................................................................................................7 Modern Human Childbirth through an Evolutionary Lens ..................................................7 Comparative Pelvic Morphology of Extant and Extinct Primate Species ...............8 Morphology of the Modern Human Pelvis ..................................................9 A Comparison to Extant Primates..............................................................12 A Comparison to Extinct Hominins ...........................................................15 The Obstetrical Dilemma .......................................................................................18 Secondary Altriciality, a Single Birth Mechanism, and Obligate Midwifery ........18 Alternatives to the Obstetrical Dilemma................................................................19 Evolution and Human Life History........................................................................24 Epidemiology of Childbirth ...............................................................................................26 Birthing Systems ................................................................................................................30 Childbirth Cross-Culturally ...................................................................................31 Traditional Midwifery Model ................................................................................32 Pain in Childbirth: Control, Acceptance, and Fear ................................................34 Birth Attendants .....................................................................................................35 Labor and Birth Location .......................................................................................39 Physiology of Childbirth ....................................................................................................41 Fundamentals of the Hypothalamic-Pituitary-Adrenocortical Axis and Cortisol .............................................................................................................41 Cortisol in Pregnancy .............................................................................................44 Cortisol in Parturition ............................................................................................46 Measuring Cortisol in Pregnant Women................................................................48 Chapter Three: Materials and Methods ..........................................................................................51 Study Section A: Online Survey ........................................................................................52 Study Section B: Biological (Saliva) Samples...................................................................54 Study Section C: Standardized Questionnaires, Interviews, and Saliva Samples .............56 Standardized Questionnaires ..................................................................................56 Face-to-Face Interviews .........................................................................................58 i Salivary Samples ....................................................................................................60 Chapter Four: Results ....................................................................................................................62 Study Section A & C: Written and Oral Narratives ...........................................................62 Study Section B & C: Salivary Cortisol ............................................................................76 Study Section C: Anxiety and Fear of Childbirth Levels (Questionnaires).......................81 Questionnaires: Wijma Delivery Expectancy/Experience Questionnaire .............82 Questionnaires: State-Trait Anxiety Inventory (STAI) .........................................83 Chapter Five: Discussion & Conclusions ......................................................................................86 Future Research .................................................................................................................90 Conclusion and Recommendations ....................................................................................91 Limitations & Challenges ..................................................................................................92 References ......................................................................................................................................93 Appendix A: Individual Cortisol, Transferrin, and Alpha-Amylase Results ...............................106 Participant 2 .....................................................................................................................107 Participant 3 .....................................................................................................................108 Participant 5 .....................................................................................................................110 Participant 6 .....................................................................................................................112 Appendix B: Prenatal Saliva Collection Protocol ........................................................................113 Appendix C: Perinatal Saliva Collection Protocol .......................................................................115