My Body, My Birth; How Choice in Perinatal Care Supports Cultural Wellbeing

Abstract

There’s no one-size-fits-all when it comes to birth planning.

This thesis includes gathered stories of, and reflections from, birthing people (mothers) on their experiences in childbirth planning and perinatal care and on the role agency played in those experiences. It draws on historic childbirth practices in the United States and the case study of Ina May Gaskin and The Farm Midwifery Center as a framework of norms expressed and encountered in some birthing communities and cultures. This paper aims to be a supportive and informative piece of literature for those preparing to give birth and planning their birth experiences. As part of academic and applied work in cultural sustainability, one objective is to support mothers navigating birth planning in the United States, especially in times of globalization and the medicalization of birth practices. It aims to help readers better understand how agency in birth planning affects cultural wellbeing. This capstone illuminates the intersectionality of birth planning with identity, culture and personal power.

Discussions carried out through ethnographic interviews focused on how mothers’ experiences affected their cultural wellbeing. Themes discussed by participants included an interest in educating themselves on the science of birth; the need for cultivating supportive teams in perinatal care such as with doulas, midwives, partners and obstetrics teams (and finding those teams by whatever means necessary, even if it meant changing teams midway through pregnancy); and using statistics to be well-informed about procedures and the risks associated with them.

Mixed methodologies were employed for this capstone, including storytelling, auto-ethnographic reflections, and decolonization frameworks. I was inspired by the academic framework of Indigenous methodologies presented by Margaret Kovach in her book, Indigenous Methodologies: Characteristics, Conversations, and Contexts, with an emphasis on the Nêhiÿaw Kiskêÿihtamowin epistemology that asserts a foundation of “giving back to community” (Kovach 2009, 11). Using these values to guide the work, this project seeks to support communities of birth workers and those preparing to give birth through the future development of a website to host notable themes from the interviews and research. I interviewed friends who gave birth, with whom I shared a deep rapport, constructed over years of raw girl talk. In interviewing friends, I employed “friendship as methodology” (Owton and Allen-Collinson 2014, 284), which breaks down the traditional hierarchy of participant and researcher into an approach that feels less hegemonic and less rigid. This methodology reflects ideas presented by Kovach in creating a basket of knowledge to learn from and centering all inside that space, without a hierarchy of value given to any one idea (Kovach 2009, 45). All ideas shared by participants are viewed as contributing the same value to informal knowledge sharing, through storytelling. What resonates from hearing these stories is unique for everybody, and exemplifies the use of agency in those moments of learning.

I also explored the history of U.S. birthing practices over the course of 50 years from 1971 to 2021, to provide meaning and an understanding of social movements in U.S. birthing communities, especially those focused on the natural birth movement. I drew on Gaskin’s work with The Farm Midwifery Center as research material, such as first-hand accounts of births in her book, Spiritual Midwifery, focused on using a mind-body connection for mothers. Midwifery practices inform the assistance at The Farm Midwifery Center, which focuses on supporting women’s agency throughout all stages of pregnancy and delivery. Gaskin’s work emphasizes supporting the natural birth movement and the idea that little medical intervention is needed in the natural process of birth, especially for a low-risk birth. Through observational learning and midwifery perinatal care, Gaskin and The Farm Midwifery Center became a hub of information and experience for unmedicated birthing communities. Sharing first-hand birthing stories in published books, talks, documentaries and international events, Gaskin demonstrates the positive influence that storytelling can have on supporting the mind-body connection of a mother (Gaskin 2011, 254). It is through this informal sharing of knowledge that learning about varying aspects of childbirth can occur. By listening to a multitude of experiences from the source -mothers who have experienced childbirth- other mothers may design their own comprehensive approach to childbirth, through learning from these stories. By understanding possible experiences, the act of sharing stories can lead to a greater sense of agency in childbirth planning. Thus, I believe storytelling has a deeper value than just sharing histories, but in sharing experiences, mothers can be confident in outcomes they may encounter.

Storytelling, in this method, supports agency in choice, through understanding the myriad of possibilities in childbirth planning. Agency can be foundational to culture, through supporting cultural diversity and cultural wellbeing by the unique choices made by individuals. Narrative reflections shared in participant interviews displayed that cultural heritage and traditions may influence decisions made in birth planning, but do not predetermine how agency and cultural wellbeing are experienced in U.S. perinatal care. Storytelling proved to be a powerful tool for sharing personal anecdotes and reflecting on birth planning. Themes expressed by participants include having a supportive team, learning the science and anatomy of birth, including statistics on risks associated with procedures, self-advocacy and role fear (and thus stress) played in these experiences.

Recommendations to the field of perinatal care include supporting the mind-body connection, desires of the birthing person, and the natural flow of low-risk pregnancy (Sasser 2025) to support cultural wellbeing of birthing individuals. Through the creation of a website to host findings from this research and interviews, the goal is to support others in their agency, cultural wellbeing, and positive birth planning experiences, through the field of cultural sustainability.