Autonomous and dependent-The dichotomy of birth : A feminist analysis of birth plans in Sweden.

Abstract Objective To elicit pregnant women's perceptions of childbirth as expressed in their birth plans, and through a feminist lens analyse their wishes, fears, values, and beliefs about childbirth, as well as their expectations on partner and midwife. Design This study used qualitative content analysis, identifying subcategories, categories, and an overall theme in data gathered from women's written birth plans. A feminist theoretical framework underpinned the research. Setting A middle-sized city in northern Sweden. Participants 132 women who gave birth in an obstetrician-led hospital labour ward between March and June 2016 and consented to grant access to their birth plans and antenatal and intrapartum electronic medical records. Findings Three categories emerged: ‘Keeping integrity intact through specific requests and continuous dialogue with the midwife', ‘A preference towards a midwife-supported birth regardless of method of pain relief", and ‘"Help my partner help me" - Women anticipating partner involvement.' The overall theme linking the categories together was: ‘Autonomous and dependent - The dichotomy of birth', portraying women's ambiguity before birth -expressing a wish to remain in control while simultaneously letting go of control by entrusting partner and midwifewith decision-making regarding their own bodies. Key conclusions and implications for practice Women primarily desired a natural, midwife-supported birth and favoured a relationship-based, woman-centred model of care, based on the close interaction between woman, partner, and midwife. Midwives need to be aware of women's ambiguous reliance on them and the power they have to influence women's birth choices and birth experiences. Feminist theory and values in midwifery practice may be useful to inspire a maternity care based on women's wishes and expectations, acknowledging and valuing women's voices, and embracing the sanctity of birth and of the birthing woman's body.