'Becoming mother': An ethnography of a free-standing birth centre

Abstract

The specific aim of this thesis was to explore the culture, beliefs, values, customs and practices around the birth process within a free-standing midwifery-led birth centre (FSBC). It was done to shed light on the workings of this little known model of maternity service provision and to build on the small amount of qualitative research in this field to date. Using ethnography, I undertook participant observation within a FSBC in England over a nine month period. I interviewed thirty women who gave birth at the centre and fifteen members of staff who worked there.
The birth centre rejected bureaucratic, institutional and hierarchical modes of management commonly seen in hospitals and was run more in accord with postmodern organisational attributes of devolved decision-making and teamworking. Leadership was transformational and decentred. The birth centre staff had powerful sense of identity and ownership of the facility, forged partly through a successful campaign to resist its closure over recent years. They had a strong commitment to creating an optimum birthing environment for normal birth to flourish, which may be explained by a vicarious 'nesting' instinct on behalf of women giving birth at the centre. The model of care contrasted with Fordist assembly-line birth in larger hospitals with the staff having time to 'wait on birth' and to 'be with women'. Their relationships with women were marked by equality and altruism. Their relationships with each other reflected communitarian values and a shared purpose that I theorized was an example of social capital. Childbirth for many women at the birth centre rejected the technocratic model, connecting more to birth's social origins. Finally, a defining characteristic of birth centre care appeared to be 'matrescence' wherein staff nurtured the 'becoming of a mother.
The study provides an important insight into the values and benefits of small scale maternity care provision and the findings contrast sharply with much mainstream provision today based on large, obstetric-led hospitals.