Alternatives to the medical model of childbirth : a qualitative study of user-centred maternity care.

This thesis sets out to explore some important gaps in the sociological and feminist
understanding of the provision of maternity care and of women's health needs.
The research was concerned with an exploration of the implementation of proposals for
the provision of user-centred maternity care which emerged from the critiques of current
medicalised provision. It evaluates the effects of an attempt to provide user-centred
maternity care within the Primary Health Care sector (PHC) from both the women's and
workers' perspectives and experience.
The central questions addressed within the research have been: Firstly, to assess the
degree to which such models of service delivery provide a user centred approach.
Secondly, to identify the form of the relationship between the women users and providers
from the practices and to develop an understanding of the mechanisms of interaction
between them. Thirdly, to explore the extent to which the provision of such care is
appropriate to match women users' self identified needs. Finally, to assess the potential
of female health workers to adopt a form of provider and user relationship where the
balance of power is altered in the users' favour.
The main body of the research consisted of a qualitative study conducted in two general
practices. These were chosen as specific examples of innovative practices attempting to
provide a genuinely user-centred maternity service. The fieldwork consisted of three
methodological components:
Firstly, unstructured interviews were conducted with women users and workers. A
sample of 30 women who were pregnant for the first time were interviewed on three
occasions during their pregnancy and in the immediate post-natal period. In addition, 10
second time mothers were also interviewed post-natally. In terms of the workers', in depth interviews were conducted with midwives, GPs and practice nurses within the
PHC setting.
Secondly, observations were undertaken on the interactions between the women and
workers and between members of the PHC team during the course of the women's antenatal and post-natal care.
Finally, a structured questionnaire was used with a sample of women from one of the
practice's well woman clinic.
The research findings indicate the existence of a user-centred frame of reference held by
female health workers - especially the midwives - for the provision of health care to
women, which was opposed to the medical model. It explores the translation into
practice of this model of maternity care and identifies the way that it functioned to enable
women to exercise greater control over their health care and experience of pregnancy.
Within this model the traditional 'with woman' role of the midwife was found to be
central. Considerable convergence was found between the models held by the main
parties in the interaction - issues concerned with choice, control and the provision of
information were all found to be central to the care provided and to women's and
workers' models.
However, constraints on the effective implementation of the model were found in terms
of the influence of professionalism (particularly on the GPs) and the dominance of the
hospital system. These resulted in limits to the women workers' ability to meet the needs
of women users.