Abstract
In 2014, the official risk advice in the UK regarding birth setting was altered given scientific evidence that for low-risk groups, home births are safer than hospital births. As hospital births were previously the de facto recommendation, and pregnant women in the UK now need to consider their birth setting options carefully, many go online, seeking advice about birth setting options from their peers. In this paper, I investigate how the hospital birth setting is constructed on an online forum where women seek advice on the relative merits of various birth settings, analysing posters’ constructions of the hospital birth setting using Foucauldian discourse analysis. Findings reveal that the hospital birth setting is characterised either as the best and safest place to ensure safe delivery due to on-site biomedical experts and technology, or it is constructed as dehumanising, involving unnecessary intervention-related risks to mother and baby. The majority of the threads are critical of the hospital birth setting. Besides these findings, this paper contributes methodologically to the study of birth settings as it adopts a cultural approach supported by discourse analysis, illustrating the metapragmatic context within which birth setting decisions are made. As women’s perspectives on the birth setting issue are in focus, findings regarding women’s satisfaction with the various options are valuable for healthcare professionals who support women with birth setting decisions, as well as obstetric and maternity practitioners in the hospital setting. The extent of posters’ critique of the hospital birth setting suggests the need for further research.
Highlights
The most commonly chosen birth setting in the UK is the hospital obstetric unit with, for example, 87 % of women in England giving birth in hospital obstetric units in 2012, 9 % in midwifery units situated on the same site as an obstetric unit, 2 % in freestanding midwifery units, and 2 % at home (Department of Health 2013)
One of the most recurrent positive constructions of the hospital birth setting is that of added safety achieved through closer proximity to medical practitioners: (1) There is, a risk in hospital too but it is more likely that you will be able to get treated by a specialist team sooner
This is supported by narratives where women explain that they and/or their child could have died in childbirth, had they chosen home birth, for example: (2) My son and I could have died [...] if we had not been in hospital with a brilliant obstetrician and many midwives there at the touch of an emergency button
Summary
The most commonly chosen birth setting in the UK is the hospital obstetric unit with, for example, 87 % of women in England giving birth in hospital obstetric units in 2012, 9 % in midwifery units situated on the same site as an obstetric unit, 2 % in freestanding midwifery units, and 2 % at home (Department of Health 2013). Hospital obstetric units have been promoted for many decades as the safest and most responsible birth setting (Armstrong 2010; Coxon/Sandall/Fulop 2014; Nolan 2015), the National Institute for Health and Care Excellence (NICE), which provides independent, authoritative health advice in the UK, recently recommended home birth as the optimal choice for women at low risk of complications (NICE 2014), given evidence of its safety for low-risk groups (Brocklehurst et al 2011). As this advice partly repeals or heavily qualifies previous risk guidance where hospital births were promoted as the best, safest birth setting option, pregnant women in the UK find. Investigating discursive constructions of the hospital birth setting helps to expose some of the cultural parameters of the birth setting debate (Coxon 2014)
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