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.