The political economy of birth choice : mothers' experiences seeking homebirth care in a felonious state

Graduation date: 2011In this ethnographic study, I examine how women living in downstate Illinois decide to give birth at home. I view decision-making as a process that unfolds throughout pregnancy and continues into the postpartum period, contextualizing "choice" in a region where homebirth is a politically and socially marginalized practice. The methodology bases itself in modified grounded theory, bringing together initial survey research, in-depth, semi-structured interviews with 21 homebirth mothers, and two follow-up focus group discussions. I draw from and build upon insights in critical medical anthropology (CMA), feminist bioethics, and anthropological theories of embodiment. Findings reveal that women decision-making processes center around three, chronologically ordered themes. First, when women make the initial decision to birth at home, they directly reflect upon past birth experiences (their own and/or those of close family and friends). This period of reflection leads women to articulate critiques of the technocratic model of birth as well as to voice a common desire for shared decision-making during pregnancy and labor. Second, as women seek they often face social and economic barriers in the process, especially in regions without a licensed provider. Nonetheless, homebirth mothers desire and actively work toward combining care from both homebirth providers and the formal biomedical system. Finally, after the birth, women talk with others about the existence and benefits of homebirth in the hopes of generating a greater awareness and acceptance of multiple models of maternity care. Recommendations from this study include a restructuring of the dominant political discourse surrounding homebirth away from a debate over biomedical notions of risk. Instead, I advocate for re-framing the debate by echoing Bridgette Jordan's call for mutual accommodation (1978) between birthing models as way of understanding and negotiating multiple ways of defining what it means to have a "safe delivery." I conclude by emphasizing the need for a debate that puts the diverse voices and needs of birthing women at its center with the ultimate goal of creating a maternity care system that serves the interests of more mothers and babies