Improving Maternal Health in a Techno-Rational Society: A Comparison of Mother's Groups in Two Countries

Background and Purpose:

The United States' health care system is built on a techno-rational model of efficiency, calculability, predictability, and control. More money is spent on maternity care than most other developed countries; however, the U.S. has increasingly poor maternal health outcomes. In this high cost medicalized environment, technology is seen as the ultimate tool to solve health problems, to be used whenever possible instead of only when medically necessary. The risks associated with this model of care are high, increasing the health dangers to women and replacing a natural process of pregnancy and birth with surgical procedures in which women are losing their autonomy. Exacerbating the loss of self-trust and self-confidence, new mothers experience significant changes in the size and composition of their social networks. Thus, motherhood as an institution may be dehumanizing, alienating, and isolating to women.

In this context, we considered the social determinants of women's reproductive health by examining a group model of care. We examined how mother's groups were a source of supportive relationships, empowering new mothers by helping them to process traumas experienced during pregnancy, birth, and the postnatal period.  We examined how individual women's health changed over the course of their membership in their mother's groups through social, emotional and/or instrumental support. Finally, we examined differences in the characteristics of mother's groups in an individualistic setting (the U.S.) with characteristics of groups in a pronatalist setting with state sponsored public health care (Australia).

Methods:       

Feminist ethnographic methods were used during five years of fieldwork with members of eight mother's groups in two countries, the U.S. and Australia.  From these groups, twenty mothers between the ages of 21 and 40 years old were selected using snowball sampling and interviewed about their expectations and experiences with pregnancy, birth, and their postpartum health. Interviews were transcribed verbatim and coded using NVivo.  Coding themes utilized in this study were based on concepts and relationships established across literatures in the fields of nursing, midwifery, public health, anthropology, psychology, sociology, and social work.

Results:

Although many women expected a high degree of control and predictability throughout pregnancy and birth, they experienced significant mental, physical, and emotional trauma under a techno-rational model of medicalized maternity care. These experiences left women with feelings of disconnection between mind and body -- an alienation of self. Mother's groups were a source of empowerment, helping women to process their negative experiences, broker resources to improve their personal health, increase their social capital, and pursue educational and employment opportunities. Lastly, we found important differences in the strength and longevity of social ties among mother's groups in Australia versus the U.S.

Conclusion and Implications:

Supportive relationships found in mother's groups are powerful social forces that can improve maternal health, increase women's autonomy, and reduce health care costs in the United States. Institutionalizing mother's groups into the existing health care system of the U.S. can counter the negative effects of the techno-rational model of health care and the isolating aspects of motherhood in America.