Understanding Maternity Care Decisions
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The complexity of understanding “choice” and decision-making in the U.S. context of maternity healthcare is fostered by competing, and often polarized, notions of how women conceptualize, approach, and experience pregnancy and childbirth. My research draws on understandings of patient-provider dynamics, the changing nature of medical authority, and patients as consumers of knowledge in an effort to analyze the experiences and healthcare decisions of women when navigating maternity care as a first-time pregnant woman. Drawing on 50 semi-structured interviews with nulliparous women, I find that women’s conceptualizations of, and decisions around, birth do not strictly adhere to the predominant cultural framework of understanding birth as medical or natural. Rather, women’s narratives of maternity healthcare decision-making underscore the importance of other belief systems, such as perceptions of risk and beliefs about the body that compete with and/or complement cultural discourses surrounding. Moreover, their conceptualizations of birth inform distinctly different approaches to decision-making and their level of engagement with the planning of birth, particularly in terms of how much “effort” constructing birth experiences may entail. Further, I examine the role of individual-level experiences described by pregnant woman as influential for their shaping their experiences of pregnancy, including the need to manage pregnancy-related advice when making decisions about care. I find that visibly pregnant women perceive advice as unavoidable, omnipresent, and, for some, invasive to their understanding of their public selves as autonomous. The reception, assessment, and negotiation centered on pregnancy advice inform women’s healthcare decisions, relationships, and ways of navigating social spaces. My dissertation contributes broadly to scholarship on reproduction by examining individual women’s conceptualizations of pregnancy and birth outside of the existing framework of medical and natural in an effort to reevaluate the implications of context for individuals when navigating pregnancy and birth planning. My findings challenge the notion that a theoretical framework of medical or natural is the only or best way to examine how women experience pregnancy, given the salience of other factors identified in the narratives of women as important in their decision-making. Additionally, this research contributes to empirical understandings of healthcare decision-making by highlighting and analyzing additional factors, such as risk construction, embodiment, and social “policing,” as salient for decisions about healthcare and experiences of pregnancy and birth, more generally.