Women's Experiences of Attempted Access to Alternative Birth Models in Contemporary Ireland

Abstract

Maternity care in contemporary Ireland is situated within a medical model of birth that conceptualises pregnancy and labour as potentially pathological and inherently risky. Grounded within this paradigm, maternity services are consultant-led and hospital-based. However, mirroring international trends that promote service user choice and woman-centred care, the Irish Department of Health launched the National Maternity Strategy in 2016. The strategy attempts to organise maternity service provision around women's preferences and optimise choice for childbearing women. Thus, alternative models, such as birth at home or in a Midwifery-Led Unit, appear to be more accessible than they once were. Through this hermeneutic phenomenological study, I have captured, during the strategy's implementation period, the phenomenon of women's lived experiences of access - or attempts of access - to these options. Underpinned by a theoretical framework of feminism, I address the ways in which dominant biomedical ideologies around childbirth and the female body continue to collude with State and hospital policies to regulate women's reproductive choices and restrict access to alternative maternity care options, even for low-risk women living in the service-rich area of the North-East. For the study participants, access to alternative birth models was constrained by obstetric policies regarding acceptable time frames in relation to the length of pregnancy and labour. Furthermore, access was dependent on medical definitions of risk, as seen in the process of the consultant sign-off. Access was also bounded by the quality (or lack of) information provided to participants by healthcare professionals during the antenatal period. Furthermore, women's birth choices were dismissed by healthcare professionals, some of whom used the Eighth Amendment as a framework for coercion. Thus, despite the fact that maternity care policy uses pro-choice rhetoric, the phenomenon of women's lived experiences of attempted access to alternative birth models is one of inconsistency and constraint. However, women work to counteract these constrains and obstetric discourses through celebrating a multiplicity of knowledges and continuing their attempts to access alternative models of care.