Providing birthing services in rural health networks: coping with change in New York State

Politics in the birthing room

Women have always braved their way through childbirth one way or another. The hands surrounding them as they make their journey have offered many things. For some it has been herbs or a totem to hold. For others, it has been a tether to a beeping machine or a drug to transform the experience. No one has yet found the method(s) that addresses every pregnant woman's fear or pain during labor and birth. And no one can truly guarantee that all will be okay. The contemporary medical profession offers to shoulder the burden for women by "taking care of it for them," The managed care industry assures the public that they will provide pregnant women with the highest quality of care and the greatest decision-making power. Elected officials promise that they will save women and newborns from unscrupulous legal practices and from the abuses of managed care. But these goals, for better or worse, have yet to be fully realized. No matter the circumstances, women will continue to have babies. Their labors will be short or long, will occur surrounded by flowered décor or in sterile wards, and will be attended by physicians who are overburdened by the demands of maintaining a practice or by a midwife who must battle with institutional protocols to care for her clients. The battle for the political victories in women's health care will undoubtedly continue for some time to come. The strength and resolve of women and their families will determine the outcome and give voice to the consumer and the midwife in the board-room, in the hearing room, and in the birthing room.

Health promotion and preventive measures: interpreting messages at midlife

In this article, the authors provide important insight into the cultural messages that midlife women receive about preventive health care. Data were collected from 24 rural women as part of an ongoing project on midlife women's health. Kleinman's model of the popular and professional health care sectors was used to examine the data. There is clear evidence of clashes between the orientations and expectations of these sectors. Women's experiences reveal some consistent themes that contextualize their preventive health pursuits: time constraints, claims for expert knowledge, salience of family history, and the inclusion of nonallopathic resources as part of the professional realm. At the macrolevel, messages regarding women's responsibility for their health are ubiquitous. At the microlevel, women must negotiate among competing messages and resources and a health care system that often confounds their efforts. These contradictions must be addressed before there are long-term effects on the health of midlife women.