Victoria University of Wellington
"Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers.
Degree: 2020, Victoria University of Wellington
In Aotearoa New Zealand, healthy women giving birth for the first time may plan to give birth in range of settings - from home to a tertiary hospital where surgical and anaesthetic services are available. Each birth location has its own culture, and the extent to which this culture influences the birth experience lies at the heart of this research. Just twenty-three percent of first-time mothers experience a normal birth with no obstetric interventions, and the chosen place of birth is implicated in this statistical outcome. Tertiary maternity settings report the highest rates of birth interventions, even for healthy women who can anticipate straightforward labour experiences. Among the most frequently used birth interventions are labour augmentation procedures - artificial rupture of membranes and administration of synthetic oxytocin infusions.
My critical realist ethnography aims to explore the cultural landscape within one tertiary birthing suite and in doing so to identify the generative mechanisms that influence the likelihood of labour augmentation for well first-time mothers. I begin with a retrospective chart review to uncover the magnitude of the use of augmentation procedures for a sample of healthy women presenting in labour to the birthing suite over one calendar year. Interviews with women who experienced long labours yield insights about their decision-making with respect to augmentation. Focus groups and interviews with midwives and obstetric doctors contribute an understanding of factors associated with their use of augmentation, and a period of non-participant observation in the birthing suite illuminates the nuanced ways the unit culture contributes to the permissive use of augmentation procedures in this birthing environment.
Findings reveal that sixty percent of women experienced labour augmentation procedures and for one third of them, the augmentation was not indicated according to the clinical guideline in use at the time. Pressure to be “moving things forward” characterises the birthing suite culture. The identified generative mechanisms that combine to influence the likelihood of augmentation include a lack of belief in birth, not valuing midwives, the education and socialisation of midwives and doctors, and the industrialisation of birth - all underpinned by available social discourses about being a good mother, a good midwife or a good doctor.
Ironically, the very attributes that make the tertiary hospital the ideal place to be when birth is complex or the unexpected happens (‘poised-ness’ for action, being a ‘well-oiled machine’ for emergency care, surveillance and control) are the same attributes that create a dis-abling environment for physiological first birth to unfold at its own pace. The ‘perfect system’ is in place; a well-embedded midwifery-led continuity of care model incorporating seamless and integrated secondary referral processes. But despite this potentially enabling model of maternity care, once ‘nested’ within the tertiary hospital setting the impact of social,…
Advisors/Committee Members: Maude, Robyn, Davis, Deborah.
Subjects/Keywords: first birth; labour augmentation; critical realism; ethnography; place of birth
to Zotero / EndNote / Reference
APA (6th Edition):
Miller, S. (2020). "Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers. (Doctoral Dissertation). Victoria University of Wellington. Retrieved from http://hdl.handle.net/10063/9179
Chicago Manual of Style (16th Edition):
Miller, Suzanne. “"Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers.” 2020. Doctoral Dissertation, Victoria University of Wellington. Accessed October 28, 2020.
MLA Handbook (7th Edition):
Miller, Suzanne. “"Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers.” 2020. Web. 28 Oct 2020.
Miller S. "Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers. [Internet] [Doctoral dissertation]. Victoria University of Wellington; 2020. [cited 2020 Oct 28].
Available from: http://hdl.handle.net/10063/9179.
Council of Science Editors:
Miller S. "Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers. [Doctoral Dissertation]. Victoria University of Wellington; 2020. Available from: http://hdl.handle.net/10063/9179