Giving birth in hospital places : an analysis of the management of birth in two obstetrical settings

This research addressed two questions. What is the social construction of labor and delivery in the everyday world of the hospital, and what happens to women who give birth within this hospital world? To answer these questions, comparative data were gathered on two hos-pital settings, providing descriptive accounts of birth in two medical settings. Community Hospital and Riverside Medical Center were compared in terms of obstetrical care, birth rituals and practices, staff norms regarding patient behavior, and the work groups that comprise the social world of the obstetrics ward.

The primary methods of data collection included field work conducted over a two-year period and patient data gathered through a quota sampling design.

Obstetrical action at the two hospitals was analyzed according to a place perspective, considering the influence of place on the management of birth. Obstetrical places were contrasted across settings. Changes of place within settings were examined, pointing of new perspectives on birth. "Out-of-place" happenings in ward life were described. The possibility was raised that changes in obstetrical places may be "illusions of place," rather than substantive alterations in the perception and management of birth in hospital settings.

The birth practices of Community Hospital and Riverside Medical Center were similar, with those at Riverside tending to be more interventionist, with less variation among health practitioners.

The birth practices at both hospitals were undergoing change, which had inter-actional and medical consequences.

Staff norms regarding patient behavior consisted of three com-ponents: (1) proper demeanor, (2) laboring well, and (3) an absence of trouble.

Team work between doctors, residents, nurses, and anesthesiologists was essential, with the primary task being successful births measured in terms of good medical outcomes for both baby and mother.

Suggestions for future research were presented.