Croker, Felicity A. (2007) Perceptions, constraints and labour relations: health delivery services to birthing women in rural and remote areas of North Queensland. PhD thesis, James Cook University.

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Abstract

Although childbirth is a defining life event for most women, those in rural and remote areas of Queensland often lack choice and control over this significant experience. Childbirth is embedded in a myriad of complex and competing social, political and cultural discourses which affect both maternity practices and the quality of a woman’s birthing experience. As the result of current health policies, centralised maternity facilities and the difficulty in recruiting suitable health professionals for rural practice, birth normally takes place in a large regional centre, under obstetric supervision. Relocation for birth separates women from family and support networks. Medical intervention in the birth process is common and cultural needs are difficult to accommodate. Despite the numerous Australian reviews of birthing, gaps in the literature indicate that there is a need for qualitative, sociological research that evaluates women’s satisfaction with maternity care in rural and remote areas.

Thus, the purpose of this study was to explore the experiences and perceptions of childbearing women and maternity care providers in four selected rural and remote areas of North Queensland. The aim was to document these women’s birthing choices and expectations as well as their assessments of the experience and the services provided. Their views are compared with those of the maternity care providers.

Recognising that the quality of women’s birthing experiences is influenced by complex interpersonal, structural and ideological issues, this study synthesises postmodern insights with the political and moral imperatives of feminist emancipatory research. The theoretical approach reflects the cultural turn in sociology by being grounded in material reality while recognising the interplay between discursive social constructions and the complex specificity of real lives.

Contemporary feminist ethnography provided appropriate interpretive research techniques for this exploration of the sensitive topics of birth and the associated relationships between women and maternity care providers. Insights were gained through field notes, community profiles, participant observation and in-depth interviews with 48 participants, enabling identification of patterns of experiences and interpersonal dynamics.

The findings provide insights into the multiple macro and micro level influences on birthing experiences. Interwoven throughout the accounts are discourses around choice, risk and trust. Although participants’ views on birthing covered a spectrum, the major themes which emerged were related to birthing options, quality of care, social and emotional support needs, socio-cultural background, and previous experiences. As well, as insights into effective models of maternity care for rural and remote settings were identified. There was a tendency toward high satisfaction among women who birthed locally in the high support, low technology rural/remote setting. This was also reflected in many of the maternity care providers’ accounts. Interactions between birthing women and maternity care providers and amongst the health professionals impacted significantly upon the quality of care and subsequent satisfaction across the birth experience. Of concern in the findings were the endemic interpersonal conflicts within families and workplaces, which can be related to gender relations and the culture of violence in wider social structures. This, along with the need to recruit and retain health professionals sensitive to the diverse needs of childbearing women and competent in advising and supporting them, was identified as a major challenge for the maternity services.

This study identifies factors which enable or constrain the effective delivery of rural/remote maternity services and the subsequent satisfaction of childbearing women with giving birth. It makes several unique contributions. First, it identifies the impact that interpersonal interactions have upon the satisfaction of birthing women, and the retention of rural/remote health professionals. Second, developing relational genograms creates a dynamic model of social organisation that has predictive possibilities, enabling identification of problems and intervention. Third, the evident success of a rural model of maternity care provides sound support for advocates of rural birthing. Fourth, it proposes practical ways to address the identified insider-outsider phenomenon and to enhance trusting, concordant relations. Finally, the qualitative data has provided detailed understandings of the strengths and limitations of maternity services not evident in official reports.

Item ID:	2149
Item Type:	Thesis (PhD)
Keywords:	Queensland, rural areas, remote areas, maternity care, birthing experiences, sociological research, choices, satisfaction, perceptions, childbearing women, retention, health professionals
Additional Information:	Appendix 12 (field work images) is not available through this repository.
Date Deposited:	09 Apr 2009 03:08
FoR Codes:	16 STUDIES IN HUMAN SOCIETY > 1601 Anthropology > 160104 Social and Cultural Anthropology @ 0% 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111708 Health and Community Services @ 0%
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