Phyllis Moen Rachel Kulick University of Minnesota
This dissertation research completes an ethnographic field study of contemporary home health care ? specifically home birth ? in the United States and the Netherlands. In comparison to similarly developed countries, the U.S. and the Netherlands are both outliers with respect to the organization of maternity care. In most developed countries, birth takes place in hospitals, hospital-based midwives provide primary care, and physicians manage complicated cases. In the U.S., however, midwives are relatively underutilized and physicians attend more than 90 percent of all births. Home birth in the U.S. is extremely controversial and eleven states ban the practice entirely. In the Netherlands, on the other hand, home birth and independent midwifery are essential components of mainstream maternity care. Physicians and midwives have formal arrangements for collaboration and, in recent years, 30 percent of births have taken place at home. Given these distinct cultural and institutional arrangements, this investigation asks: What does it mean to give birth at home in the U.S. and the Netherlands? How do birth practices and social institutions (e.g., professional organizations, insurance systems, government health agencies, and the law) shape home birth and influence its meaning? How does the location of home birth with respect to the broader health care system (e.g., incorporated or marginalized) affect the autonomy, power, and agency of women?
Broader Impacts: This cross-national study will advance theoretical understanding of the medicalization, a process especially relevant to women?s life experiences. It will also examine and provide knowledge about medicine and health care as cultural products, developed in gendered ways. Moreover, it brings a systematic and rigorous analysis of the Dutch maternity care system to U.S. scholars, policymakers, and birthing women that can inform debate on the future of U.S. health care. In a health care system necessarily concerned with cost containment, safety, and patient satisfaction, much can be learned from the Dutch system of home health care.
