UpDate - Vol. 11, No. 30, Page 5
May 7, 1992
Study focuses on why women opt for home births

     Pregnancy is a time for questions: Breast feed? Bottle feed?
Cloth diapers? Disposable ones? Go back to work? Stay home? And what,
oh what, am I going to name this baby?
     But according to Kathleen Turkel, assistant professor of women's
studies, one of the first questions a pregnant woman must ask and
answer is simply, "Where is this baby going to be born?"
     Turkel, who earned her bachelor's degree from the University in
art history and political science in l973, her master's in political
science in 1981 and her doctorate in urban affairs in 1989, followed
the establishment of a birthing center for her doctoral dissertation.
Recently, her research has expanded to include a study of women who
have given birth in their homes in the state of Delaware.
     "My research is both theoretical and empirical in nature," Turkel
said. "It's about the ideology of technology and how it shapes us as a
culture. I look at the law and how it shapes the possibilities for
alternatives, the conditions it sets on practitioners and the extent
to which it limits choices.
     "Childbirth is legally the practice of medicine. The law
determines who can and can't attend a birthing woman. For a legal home
birth in Delaware, technically, you need to have a licensed
practitioner attend, but you'd be highly unlikely to find one. The
people who are willing to do home deliveries are lay midwives who
don't have any legal standing in the state.
     "Some women give birth at home because they don't have any other
options. I wanted to study women who have choices but choose to give
birth at home. I wanted to look at how they view birthing, how they
understand the law and to what extent the law was a concern.
     "What I found was that the women were very different
ideologically. For example, when I asked if they considered themselves
feminists, I got an enormous range of responses--everything from 'Of
course' to people who considered themselves anti-feminist.
     "What they did agree on was that this was a decision in which
they demanded control. They refused to grant that the law had any
right to tell them what to do. They were clear that the circumstances
of birth should lie with the birthing woman and not with the state.
     "These women also all had a firm belief that pregnancy and birth
are healthy processes and that they wanted to be able to give birth in
a way that they would feel most comfortable. They wanted to stay home
in familiar surroundings and saw no reason to move, even to a birth
center. They saw movement as a form of interference."
     These women had "clearly evaluated what the birthing experience
would mean for themselves, their families, and their children," Turkel
said.
     And, she said, research shows that babies born at home to mothers
with low risk pregnancies are not placed in extra danger.
     "All out-of-hospital births have been characterized as risky in a
way that they are not," Turkel said. "We have this TV idea of
pregnancy that everything is going to go wrong when in reality it is
only on rare occasions that that happens. There is no reason to treat
every birth as if that is the imminent likelihood.  Most of the time,
childbirth is a healthy process that happens to healthy women. Women
who have their children at home are trying to avoid the technological
and intrusive experience of hospital birth. What they are seeking is a
birth experience which meets their needs and the needs of those with
whom they are close."
     Turkel said people often forget how much risk is associated with
hospital births.
     "For example," she said, "the cesarean rate is one in four for
hospital births and that process always carries with it all the risks
of major surgery. Fetal monitors that they use in hospitals also carry
a risk and can lead to C-sections by sometimes identifying problems
that don't exist.
     "And there is a greater chance that drugs will be administered in
a hospital birth and there are no drugs thought to be safe for a
fetus.
     "Home births are always unmedicated so the risk is eliminated for
the mother or child. Women who have had home births say they feel this
is much better for their babies and they also say it is important for
them to have uninterrupted time with their newborns following birth.
     In her earlier research, Turkel followed the establishment of the
Nurse-Midwifery Birthing Center, which in l986 became the Birth Center
of Delaware.
     "People who choose a birthing center are usually people who have
very clear ideas on what they want out of a birth experience," she
said. "Sometimes they are people who don't like hospitals, sometimes
they are people who lack health insurance and can cut their bills in
half by using the center. Often women who choose birthing centers are
seeking the care of nurse-midwives and the home-like atmosphere which
such centers offer.
     "Birth centers are becoming increasingly popular because of their
cost cutting-factor and also because of the added individualized
attention the women clients receive. Birth centers pay a lot of
attention to women. There are no fetal monitors and no restrictions on
movement."
     Blood pressure and fetal heartbeat are monitored, and there are
provisions for emergency transportation to a hospital if needed.
     In Delaware, as in many states, in order for a nurse-midwife to
practice she has to be aligned with a physician. The Birth Center is
backed by a group of Wilmington doctors. It does not attend high-risk
births.
     -Beth Thomas