Assessing Interactions Between Culture & Choice

[Editor’s note: This is a guest contribution about the concurrent session at the Normal Labour & Birth International Research Conference titled Assessing Interactions Between Culture and Choice. Priscilla Hall (a second year PhD student at Emory University Woodruff School of Nursing), Esther Shoemaker (a first year PhD student in the Population Health program at the University of Ottawa), and Kathrin Stoll (doctoral fellow at the Centre for Rural Health Research) each presented their research. – AMR]

Thank you Amy and readers for allowing me the great opportunity of contributing my conference analysis to Science & Sensibility.

At no other conference has choosing between concurrent sessions been so difficult. However, from the moment the schedule was posted some weeks ago I knew there was one I had to attend. Assessing Interactions Between Culture & Choice focused on today’s generation of mothers and what shapes their perceptions, experience and consequently choices about birth.

Generation Y women are today’s young mothers and will make up the bulk of midwives’ clients in the approaching years. What shapes their perspectives on pregnancy and birth? And how will their expectations impact the way they choose to give birth?

Demographics and Influences

Generation Y is loosely made up of adults born between the mid 1980s and the mid 1990s In the conference session, we reflected on what influences this generation of women:

1. This generation is extremely comfortable with technology, having craved the “toys that make the noise” including Nintendo/Sega/Xbox game consoles, mini laptops and iPods. The toys of this generation often involve one-on-one interactions with a computer rather than a friend.

2. The “Audit Society” (Power 1997) is the norm for this generation. The 1980s saw an explosion of auditing activity in UK and American society. Teachers chart performance and activities of students, employees audited their own activities for their employers and health workers began recording up to the minute activities of their patients and one another.

3. To this generation “the most desirable women aren’t women at all – they’re girls. The womanly shape, once held in esteem by the Greeks all the way up to pre-Twiggy models is seen as overweight to this generation. Smaller frames, straight figures and other pre-pubescent qualities are idealized by Generation Y women (or at least the media they consume). Not ironically, Gen Y has also been referred to as the Peter Pan Generation.

The first two in this hardly exhaustive list of predictors can help to explain how medicalized birth is quickly being assumed as the norm by today’s women. (And as Dr. Eugene Declercq of Boston University pointed out over lunch, the majority of U.S. women are satisfied with their maternity care.) In fact, as UBC doctoral candidate Esther Shoemaker points out from her mixed methods research of young women and new mothers, “Natural” birth to them does not equal “Normal” to us. Natural birth, to most of the women in her study, is synonymous with vaginal birth. Even if labor was induced, an epidural administered or forceps used, the women who gave birth vaginally experienced their birth as natural. I have witnessed this in my own Generation Y peer group of young mothers.

Further, the majority of those Shoemaker interviewed desired a vaginal birth in their antepartum interview, but also voiced an ambivalence about whether or not they actually would give birth that way when the time came. “If something happens I of course will have a c-section.” Oddly enough, perception of safety was not mentioned but the women said they would default to whatever their individual practitioner suggested.

In some cases reported, the practitioner suggested procedures to the Shoemaker participants that increased the degree of medicalized beyond what they expected for their birth. When this occurred, each of the participants changed their plans for their second birth. They either embraced the medical model completely or rejected the medical model in favor of a physiologic birth. So while they were ambivalent or passive first time mothers, they actively created their birth plans for subsequent children. The finding has important implications for today’s mothers as this was true for all Shoemakers’ participant’s whose birth experience was more medicalized than her birth expectation.

Intriguing findings in the studies:

1. Birth, to this generation, is, as UBC scholar Kathrin Stoll points out, a normal physiological process (71%), inherently risky and filled with “unavoidable complications” which necessitate technological interventions.

2. Of the women Stoll interviewed, 70% worried about how they and/or their partners would perceive their bodies during and after pregnancy.

3. According to Shoemaker, who studied what happened in subsequent births among women whose first births were more medicalized than expected, one of two extremes were common. The women would either fully embrace the medical model (e.g., plan a c-section with all the bells and whistles) or she planned to birth at home with no interventions.

The findings of this session’s speakers are all interesting and important for us as midwives, childbirth educators, and activists. When shaping our message about normal birth it is important to meet women where they are, use their language and respect their experience of the world and their bodies. How will we “market” normal birth as we are privileged to know it to the coming mothers?

About Katie Fulmer:

Like many of you, I have birth on the brain and care deeply about the health and wellbeing of our mommas. I am currently a student midwife with Illysa Foster, author of Professional Ethics in Midwifery Practice. My academic focus was Medical Anthropology as an undergrad at the University of Texas in Austin and I look forward to continuing my study of maternity and child care at the PhD level.

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  1. | #1

    Thanks for a great article… I have often found this discrepancy between natural childbirth and what most women perceive to be natural childbirth puzzling.
    Putting this in next week’s Sunday Surf

  2. | #2


    Great post, Katie. Meeting your patients/clients where they’re at is so important–as is understanding how to teach to their sensibilities, biases, preferences and tendancies. I really do think this population–Gen Y moms–presents a challenge…the same challenge I am perceiving in the San Francisco Bay area where we’re currently living: folks who are intimately familiar with technology and who employ it in many ways throughout their daily lives will require extra creativity and evidence-based teaching on our part when it comes to promoting normal birth.

  3. | #3

    I think there was a session at the normal birth conference that addressed this issue of vocabulary, and that the use of ‘normal’ or ‘natural’ doesn’t mean the same thing to everyone.

    Lamaze conducted a study and found that the words ‘safe’ and ‘healthy’ had resonance and meaning that everyone could understand. I also like the word ‘physiological’ because I think it speaks to the intuitive hormonally driven process that is undisturbed birth. A physiological process is not a technical one, and it does not involve technology.

    I am slightly older than Gen Y, and was already in university when the Internet and cell phones really got going. I think that while Gen Y women are of course going to be having babies for quite some time in the future, there are also a lot of women having babies right now who are in their 30’s and 40’s, although I don’t know what the actual statistical demographics are. So there is a mix of women who grew up without such a strong connection to technology in their childhood, but who still use computers, the internet, cell phones etc. and Gen Y who have been connected in most of their lives.

    I think another aspect of this generation is that there is more awareness and more of a move towards incorporating environmentalism into everyday life, and a sense of the necessity of protecting the earth. So on the one hand there is more pervasive technology and on the other hand there is more of a trend towards green, healthy, and natural solutions. I think that this trend creates opportunity to reach a majority of women in a way that was not possible even 20 years ago, by combining the use of technology for education and the message of a ‘green’ and healthy birth.

  4. avatar
    | #4

    This is fantastic! I am just about to enter my senior year of college, after which I will go through nursing and midwifery school. I am planning to write my senior anthropology thesis on how young women (roughly my age, 18-25) perceive birth and what the media’s influence is in creating a culture of fear surrounding a “normal” birth. Is there someplace where I can view the whole article? So few people have done research on pregnancy and birth in the anthropology field, and I would love to use this article as some of my background research!

  5. | #5

    Is there any place online that we can read this research?

  6. avatar
    | #6

    Thank you all for your comments. The Research is not yet published, but I have contacted Kathrin and Esther about your request.

    Michelle – I would so enjoy connecting with you about our shared research interests. klfulmer at gmail

    Asheya – Like you, I expected to see more green mommas in the research – Especially is gorgeous, green Vancouver! There are yoga studios on every corner, however the university students in the study did not mention green, health or natural solutions. Maybe they were mostly transplants? I don’t know, but I too hope there are more green mamas in Gen Y than the study suggests.

    It’s so important that we do more of this research in other locations, and not just in university settings so we can determine how Gen Y women are framing birth. Looks like Michelle and I are ready to explore the topic further!

    Thank you Mama and Kim for your professional insights into the topic. I look forward to continuing the discussion and exploration of meeting women where they are.

  7. avatar
    Kathrin Stoll
    | #7

    Thanks Katie for your interest in my research and your thoughtful analysis of the conference session.

    I have copied below the % of university students who agreed with the following statements about childbirth (N=3680).

    Birth is a normal process: 97%
    Childbirth is inherently risky: 66%
    Technology is necessary to deliver a baby: 45%
    Complications in the delivery room are unavoidable: 28%
    I am afraid of what the labour and delivery process will do to my (my partner’s) body: 70%
    Not all is lost: Vaginal births are an outdated method for delivery of children: 2%

    These findings suggest that students’ perception of birth as a normal process is not incompatible (as we may think) with the view that birth is risky and requires technological interventions. It seems that attitudes towards ‘normal’ birth among students are a reflection of current obstetric practices and the ‘ culture of fear’ that surrounds birth.

    We are in the process of preparing a manuscript based on our findings. We did publish a paper in 2009 about student’s preferences for a vaginal delivery or cesarean section which includes a comprehensive analysis of reasons for this choice (by gender). Here is the reference:

    Stoll, K., Fairbrother, N., Carty, E., Jordan, N., Miceli, C., Vostrcil, Y. & Willihnganz, L. (2009) “It’s all the Rage These Days”: University Students’ Attitudes toward Vaginal and Cesarean Birth. Birth, 36(2), 133-140.

    Thanks for pointing out this blog to me…

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