Control in childbirth . A material - discursive evaluation with primiparous women and their midwives

Current moves to give childbearing women more control over the birth process provided the impetus to explore the ways in which both midwives and their clients represented various aspects of control in childbirth. After an exploratory pilot study, two longitudinal studies were run in parallel. Both involved contact with primiparous women at 36 weeks antenatally and at 1 and 16 weeks postnatally. The first involved postal questionnaires sent to 126 women, and the second involved one-to~ne semi-structured interviews with 15 women. In both studies the woman's midwife was also contacted shortly after the birth. Taking a material-discursive approach, background, demographic and birth related issues which predispose to expectations and experiences of control or its lack were explored as was the relationship between control expectations, experiences and postnatal psychological wellbeing; and how midwives and their clients' assessments of the childbearing woman's control and satisfaction compare. Although the questionnaire study demonstrated a relationship between high external locus of control beliefs and low expectations of control in childbirth, the interview study highlighted the importance of other birth-related issues, such as concerns for safety, in women's control expectations. Although neither study found any effects of social class (as measured by educational achievement) on general expectations of control in childbirth, interview participants with fewer educational qualifications were likely to have more specific birth plans. There were strong relationships between antenatal and postnatal control scores, although the interviews represented control-related issues as complex. The midwives' and the childbearing women's assessments of the women's satisfaction with the birth correlated significantly, but in terms of the women's expectations and experiences of control the midwives appeared to be assessing related variables, such as mood, rather than verbal reports of control. No relationship was found between unfulfi1led expectations of control in childbirth and postnatal mood distwbance. High levels of control were associated with low levels of mood disturbance. Mood scores correlated across time, and although women's accounts of the birth became more coherent and detailed, they did not become more negative.