Table Of Content“PIZZAS ARE DELIVERED, BABIES ARE BORN”: THOUGHTS AND OPINIONS ABOUT
BIRTH AND THE MATERNITY CARE SYSTEM IN COLORADO
by
Lauren Elizabeth Easton
B.S., University of Wisconsin-La Crosse, 2011
A thesis submitted to the
Faculty of the Graduate School of the
University of Colorado in partial fulfillment
of the requirements for the degree of
Master of Arts
Anthropology
2013
This thesis for the Master of Arts degree by
Lauren Elizabeth Easton
has been approved for the
Anthropology Program
by
Marty Otanez, Chair
Steve Koester
Jean Scandlyn
April 15, 2013
ii
Easton, Lauren Elizabeth (MA., Anthropology)
“Pizzas are Delivered, Babies are Born”: Thoughts and Opinions about Birth and the Maternity Care
System in Colorado
Thesis directed by Assistant Professor Marty Otanez.
ABSTRACT
There is a current crisis in the United States in regards to maternity care standards and
accessibility. Roughly 4.3 million births happen each year in this country, and the approximately 99% of
those births occur in hospitals. Whereas at the beginning of the 20th century, only 95% of births took place
at home, by the beginning of the 21st century only 1% of births took place at home. U.S. society changed
from viewing birth as a physiological process that happens spontaneously and effectively to a legal,
medical event. There is supporting evidence that homebirths are just as safe as hospital births, yet a very
small percentage of women opt to use a midwife, have a homebirth, or give birth at a birthing center in
favor of going to a hospital for delivery. The purpose of this study is to better understand how pregnant
women choose a birthing attendant, location, and delivery method. The research is grounded in practice
theory as articulated by Pierre Bourdieu and Anthony Giddens. Snowball sampling was used to recruit
nine pregnant women from various locations in Colorado. Participants were interviewed and their
responses were transcribed, coded, and analyzed to help with the identification of the barriers keeping
women from utilizing homebirth, a safe, affordable, and natural method of delivery.
The form and content of this abstract are approved. I recommend its publication.
Approved: Marty Otanez
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ACKNOWLEDGMENTS
I would not be where I am today if my undergraduate advisor, Christine Hippert, hadn’t
introduced me to the world of maternity care. She gave me the book that has inspired this
research project, and I want to thank her for her continuous guidance and support. Indra Lusero
has also been a huge inspiration during this research endeavor. Her passion about birth and
hopefulness of the future are truly an inspiration.
It must be said that the training that I have been given during my experience at UCD has
allowed me to take on a project of this magnitude, and the completion of this thesis could not
have occurred without the guidance and support of the Anthropology faculty. I would like to
thank the entire faculty who has greatly influenced me, my outlook on the world, and my
approaches in Anthropology. Marty Otanez, my thesis chair and advisor, has spent numerous
hours talking with me about this project. He pushed me to be creative, and helped me get the
most out of this experience. I wish to thank my committee members Jean Scandlyn and Steve
Koester for their encouragement, comments, and suggestions; my project is better because of
them.
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TABLE OF CONTENTS
CHAPTER
I. INTRODUCTION: LABOR, DELIVERY, AND DECISIONS………………………………1
II. THE CADILLAC OF MATERNITY CARE ........................................................................... 5
Options Ouside of the Hospital ......................................................................................... 11
Options in Colorado .......................................................................................................... 16
III. RESEARCH DESIGN AND METHODOLOGY .................................................................. 18
Research Aims .................................................................................................................. 19
Conceptural Framework .................................................................................................... 21
IV. WHAT WE’RE CHOOSING: THOUGHTS AND OPINIONS OF NINE PREGNANT
WOMEN IN COLORADO ................................................................................................ 25
Hospital Births. ................................................................................................................. 26
Homebirths ........................................................................................................................ 31
The Role of Experience ..................................................................................................... 35
V. DISCUSSION. ...................................................................................................................... 39
VI. CONCLUSION. .................................................................................................................... 46
REFERENCES .............................................................................................................................. 49
APPENDIX
A. Question guide .......................................................................................................................... 53
B. Recruitment flyer………………………………………………………………………………55
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LIST OF TABLES
I. Characteristics of participants ....................................................................................... 25
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LIST OF FIGURES
I. Residency locations of women interviewed. ................................................................. 24
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CHAPTER I
INTRODUCTION: LABOR, DELIVERY, AND DECISIONS
Giving birth is one of the human universals shared among women, and over time, people
have developed many different strategies to ensure successful births. Every culture has its own
“way of conceptualizing birth” which serves as “the single most powerful indicator of the
general shape of its birthing system” (Jordan 1993:48). When looking from a global perspective,
we consistently see that the majority of women in the world give birth at their home, aided by
their mothers, sisters, aunts, or midwives (Jordan 1993:122-123). People opting for this method
of delivery tend to view birth as a “normal physiological process that happens spontaneously and
effectively” (Lusero 2010:1). Society in the United States differs from this approach to delivery
and instead favors a more technological approach to this natural process.
Like many industrialized countries in the world, the United States culturally accepted a
technocratic approach to birth (Davis-Floyd 2003:45-46). In the 20th century, modernization and
development in the U.S. led to “massive modifications of the traditional way of life” (Jordan
1993:128). As the human body began to be seen as a machine that needed to be and could be
fixed by highly trained professionals, birthing in the U.S. had to change. The country
experienced a massive shift from home to hospital when it comes to birth location. This shift
brought women the comfort of technology, trained physicians, and medicine, but it also came
with an increase in cost and invasive procedures, and a belief that giving birth at a hospital is the
best option for delivery. This new “locally shared view of childbirth” is what led people in the
U.S. to “have similar ideas regarding the course and management of birth” (Jordan 1993:48).
The understanding of the birth process changed from being a natural and normal process to being
a legal, medical event (Lusero 2010:1, Starr 1982). Delivering at hospitals with physicians also
caused a shift in power to occur; women lose their decision-making power to hospital personnel
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and physicians once admitted into hospitals (Jordan 1993:46). This loss of decision-making
power is a reflection of the “changes in the structure of social organizations” (Starr 1982:161).
Because the norm in this country has been to deliver babies in hospitals for over 100 years,
viewing pregnant women as patients is well established in the habitus of many citizens (Jordan
1993:49).
Approximately 4.3 million births happen each year in the U.S., and roughly 99% of these
births take place in a hospital (Sakala and Corry 2008:2). Childbirth in the U.S., like other
physiological processes, is “culturally defined as belonging in the medical domain” (Jordan
1993:49). When compared to homebirths, hospital births have higher rates of infection, higher
rates of invasive procedures, and very high cost. Despite these aspects, 84% of women believe
that their hospital experience was “just fine” (Declercq et al.2006). The national average for
cesarean sections is 32.9%, maternity care hospital charges amount to nearly $80 billion, and the
drawbacks to procedures such as receiving an epidural are almost never mentioned to expectant
mothers (Joyce et al. 2011:9, Lusero 2012:1, Childbirth Connection 2012). There is also a
discrepancy when it comes to the level of education and prenatal care among women in the U.S.
Poor women in this country do not have as much access to prenatal care and education classes as
do women belonging to middle and upper socioeconomic brackets (Jordan 1993:57). These are
only a few of the problems with the current maternity care system in the U.S., and for many
citizens, these problems are not known.
As more research on the topic has been conducted, we have the evidence suggesting that
low-risk births are just as safe at home as at a hospital, yet only a very small percentage of
women opt to use a midwife, have a homebirth, or even give birth at a birthing center (Janssen et
al. 2009:377). Based on national data collected by the Centers for Disease Control and
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Prevention, it is evident that the majority of women still prefer giving birth at a hospital with a
physician as opposed to at home with a midwife. Before change can occur in the maternity care
system of the United States, we need to understand why women are choosing hospital births over
other available options.
Current research has identified that the population most likely to use alternative or natural
forms of delivery are White, middle class, educated women (Boucher et al. 2009:121). What is
less known, however, is what specific factors led them to make that choice and what is keeping
other women from leaving hospital births behind. The purpose of this study is to better
understand the decision making process of pregnant women when it comes to choosing a birthing
attendant, location, and delivery method. This study will help us identity influential factors when
making decisions as well as the barriers keeping women from utilizing alternative safe,
affordable, and natural methods of delivery. Once we know why and how women make the
decisions they do about their delivery method and location, we can then identity the influencing
factors and address them through knowledge dissemination and policy change in the state of
Colorado.
This is an exploratory study to gather data for future studies on the subject. The
information gathered in this study will be contribute to efforts hoping to improve maternity care
in Colorado. Many birth advocates believe that women should be provided with family centered
care and options for delivery that not only fit their values, but also promote physiologic birth and
better outcomes (Lusero 2012:5). Ideally, maternity care in Colorado will shift and give priority
to effective, safe, and cost effective paths of delivery while only using risky interventions for
situations when all other measures are inadequate. This type of system would benefit mothers,
babies, and purchasers (Sakala and Corry 2008:4). Utilizing the midwifery model of care is
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