Home birth in the United States and the Netherlands: understanding women's experiences of stigma, nature, and trauma

Abstract

This is an ethnographic study of contemporary home birth in the United States and the Netherlands. Data include (1) fieldnotes collected at prenatal appointments, births, postpartum visits, and professional meetings, (2) transcripts from pre- and post-birth interviews with pregnant women as well as interviews with midwives, and (3) textual materials including statements by medical and midwifery associations and books by leaders of the natural birth movement. Analysis reveals three key components of women's experience: stigma, natural birth, and trauma. Home birth in the U.S. is seen as risky behavior and women who plan such births are labeled risk mothers. Women cope with this stigma by employing isolation and secrecy, attempting an education campaign, or seeking comfort in a family tradition of alternative approaches to health. In the Netherlands, home birth is part of the mainstream health care system. In the absence of stigma, structures for collaboration between midwives and physicians facilitate relatively smooth interactions. An international discourse of natural birth informs a script for how to accomplish home birth in the U.S. This script emphasizes a warm, dark, and quiet environment, continuous labor support, and the achievement of an altered state of consciousness. A different script operates in the Netherlands - one that focuses on home birth as ordinary (as opposed to extraordinary) and is based on a tradition of independent midwifery, insurance industry support, and professional postpartum home care. Home-to-hospital transport is a traumatic experience in the U.S. - not so much because of the obstetric complications that necessitate the transfer as because of the disruption of beliefs and values that occurs when women move from the midwifery to the biomedical model of care. In the Netherlands, non-Dutch women with a medicalized view of birth experience a similar rupture between their worldview and a system that promotes unmedicated, low-intervention birth.