Pregnancy, class and biomedical power : factors influencing the prenatal care experiences of low-income women in an Oregon community

Graduation date: 1994Low-income women in an Oregon city of approximately 35,000 inhabitants have\ud limited access to prenatal care services during their pregnancies. The purpose of this study\ud was to uncover the impacts of several factors on the experiences of twenty-seven health\ud department clients with public health department prenatal care practitioners and with local\ud private obstetricians. Ethnographic interviews were conducted with the clients, two health\ud department practitioners, two local obstetricians, and one local direct-entry midwife. The\ud focal finding that emerged from the research was that the clients preferred the care of the\ud health department practitioners to that of obstetricians, even though the health department\ud providers could not deliver the women's babies.\ud The major impacts on the clients' experiences included fragmented service delivery\ud and availability, economic and social restrictions on prenatal care options, biomedical\ud constructs of a healthy pregnancy, and provider role constructions and attitudes towards\ud Medicaid recipients and uninsured pregnant women. Local physicians' mechanistic\ud philosophy, professional dominance and profit orientation afforded them a narrow\ud understanding of the needs and identities of low-income women. Local public health\ud workers are less professionally autonomous than medical doctors but their service\ud orientation allowed them the potential to better serve low-income clients.\ud Based on the twenty-seven clients' perceptions of their care providers and the\ud services available to them, recommendations are made for more empowering,\ud comprehensive prenatal care services in this county. Recommended changes to the public\ud health system entail expanded funding for more appropriate programs and to establish\ud continuity of care for health department clients from pregnancy through the postpartum\ud period. The incorporation of direct-entry midwives into the prenatal and birthing care\ud options open to low-income women is also recommended. Senate Bill 1063, which creates\ud a process for direct-entry midwives to become state-licensed in order to be reimbursed by\ud the Office of Medical Assistance Programs for perinatal services, is considered in terms of\ud its implications for low-income women, the Oregon community of direct-entry midwives,\ud and the texture of Oregon reproductive health care