Views on Medical and Natural Birth in University Women and Men

The prevailing childbirth care approach in the U.S. and other industrialized nations has been described as "medicalized," which involves treating birth as a medical condition requiring the assistance of highly specialized care professionals and technological intervention (Davis-Floyd, 2001). The dominance of the medical birth paradigm is reflected in 21st century data indicating that over 98% of U.S. births took place in hospitals (Martin et al., 2010), where women routinely receive one or more procedures such as IV antibiotics, synthetic oxytocin, or episiotomy; similarly, more than 40% of women reported having had labor induced, and 30-32% had cesareans (Declercq, Sakala, Corry, & Appelbaum, 2006; Martin et al., 2010). These data underscore how medicalized birth is the U.S.'s current normative standard, whereas physiologic birth, which relies primarily on the innate capacities within mothers and fetuses, is in the minority position (Soliday, 2012).Unfortunately, investment in intensive medical intervention during the perinatal period has failed to translate into measurably better maternal or newborn health outcomes at the population level (Moos, 2006; Sakala & Corry, 2008). Health care reimbursement structures and defensive practice have been cited as among the reasons for the widespread acceptance of medicalized birth (Francis, 2014; Perl, 2010; Sakala, 2006). However, to say that systemic and professional influences are wholly responsible for the dominance of the medicalized birth paradigm may be inaccurate, as women have historically had some role in shaping the care culture through their uptake of procedures, particularly those with the promise of treating pain (Pitcock & Clark, 1992; Wertz & Wertz, 1989). This is not to say that women are making care decisions autonomously or with the benefit of full information. To the contrary, women have reported that they felt pressured to accept interventions that they either felt poorly informed about or did not want (Declercq, Sakala, Corry, Applebaum, & Herrlich, 2013; Soliday, 2012). For this reason, we focused this study on birth attitudes of women and men who had not yet given birth, i.e. "preparents," because they have matured in a medicalized birth culture but have not yet directly experienced care that could influence their perspectives.According to Bronfenbrenner and Evans (2000), cultural standards influence individual development, which include views on medical approaches and care (Cassidy, 1995). From that perspective, the prevailing medicalized birth culture would be reflected in individual views, with greater weight assigned to the normative, medicalized birth paradigm relative to physiologic birth. We tested that prediction by assessing medicalized and physiologic ("natural") birth attitudes in university women and men who had not yet become parents. Traditional-age college students are an appropriate sample because the average age of first birth in U.S. women is 26 years (Martin, Hamilton, Osterman, Curtin, & Mathews, 2015), and men in this age range have the highest fertility rates (Martin, Hamilton, Osterman, Curtin, & Mathews, 2013). Understanding this population's views is essential to developing effective, evidence-based birth information campaigns, which could have a greater impact among preparents because they are not yet under the stress of impending parenthood.Birth Philosophy Background and ScaleThe Birth Philosophy Scale (Wilson & Sirois, 2010) was originally designed to assess natural and medicalized (medical) birth philosophies. The authors conceptualized the two dimensions as reflecting distinguishing views on the social/relational nature of birth, technology use, and perceived risk. Their 11-item natural birth scale contains items such as, "I would want to have a good relationship with my birth attendant," which captures the social/relational aspect; "Some routine medical interventions during labor seem unnecessary," addresses views on technology, and "Giving birth is a normal event," reflects perceived risk. …