Women's experiences of planning home births in Scotland : birthing autonomy.

The general aim of this study was to provide an in-depth exploration of the experiences of a group of 30 women who planned home births. This was to expand on the small amount of qualitative research in the field and suggest avenues for further research. With this general aim, I analysed the women's experiences in relation to the contexts in which they planned home births in order to provide a useful account for the women in the study, those who may plan home births in the future, as well as clinicians, managers and policy-makers involved in maternity services. I considered some of the wider political, social and historical discourses, which underpin the present situation in Scotland regarding home births. While I acknowledged that these are unstable reference points, they were useful in gaining insights into the current situation. This was particularly the case when looking at home birth as part of a complex interplay between dominant and subordinate ideologies, which were partially played out through gender relations symbolised by the male doctor and the female midwife. A postmodern reading of feminisms provided the conceptual tools to examine diverse belief systems around birth in relation to women's narratives. Suspending "truth" enabled diverse knowledges to become more visible. This validated women's experiential knowledge which could then be placed alongside other knowledge systems, and examined in terms of dominant and marginalised ideologies. The project became one of conflicts and silences, searching out and listening to, and making visible "other" voices. This raised issues of power, control, autonomy and resistance. In most cases I interviewed each woman twice before her baby's birth and twice following the birth. Interviews were usually 1 Y2 to 2 hours in length, taped and transcribed. A qualitative software program, NUD*IST was used to assist with analysis, but the conceptual framework for the analysis remained rooted in a postmodern feminist approach using a relational voice methodology. The main findings were that National Health Service (NHS) community midwifery services were based on an attenuated technocratic model of birth. This imposed a philosophy and structure of care that prevented women and midwives from developing alternative ideologies based on their own knowledges. It prevented women and midwives from forming trusting, supportive relationships, which stand at the core of holistic philosophies of birth. Women and midwives were often obliged to draw on subversive techniques to use their knowledge and skills in order to make the best of a system which by definition could not be woman-centred or holistic. The main conclusion was that birth requires to be socialised rather than medicalised, so that technology and medical practices can be developed and used to support women and babies, and midwifery practices when necessary, rather than birth being technocratised and social practices used to humanise an essentially inhumane system of care.