Women's childbirth preferences and practices in the United States

Over the past two decades, research on childbirth worldwide has documented women's varied perceptions of and decision-making regarding childbirth. Scholars have demonstrated the impact of medical authority, religion, perception of risk, and access to care providers on the decisions women make about where to have their babies and with whom. Virtually all research on how women make these choices, however, has focused outside the United States. To address this gap in the literature, we analyze data collected during 2004–2010 through 135 in-depth interviews with women in the U.S. who have had hospital births, homebirths with midwives, and homebirths without professional assistance to explore the factors that led them to the births they had. We supplement these interview data with archival analysis of birth stories and ethnographic data to offer additional insight into women's birth experiences. In our analysis, we utilize Pierre Bourdieu's concepts of “habitus” and “field” to examine the ways women's preferences emerge and how a sense of risk and safety shape their decision-making around pregnancy and parturition. Our findings indicate that while women's birth preferences initially emerge from their habitus, their birth practices are ultimately shaped by broader structural forces, particularly economic position and the availability of birth options.

► Examines the meaning of childbirth and definitions of childbirth risk.
► Presents data from a multi-year study of women choosing homebirth with a midwife, hospital birth, and unassisted childbirth.
► Identifies distinct frameworks underlying birth preferences: scientific-medical, natural family, and religion-centered.
► Utilizes Bourdieu's concept of habitus to examine the interface of women's preferences and social structures in the U.S.
►  Points to ways that availability of birth options and economic position constrain women's agency in birth choices.