An ethnography on perceptions of pain in Dutch "Natural" childbirth.

ABSTRACT

OBJECTIVE: this study offers insight into how women perceive childbirth pain and how they make decisions about whether to use an epidural during childbirth in the low technology context of the Netherlands maternity care system. DESIGN: ethnographic research consisting of participant observation at births and prenatal and postnatal appointments; semi-structured interviews with a sample of recently post-partum women; coding and triangulation of data to determine key themes in the interviews. SETTING AND PARTICIPANTS: the study was carried out with participants in thirteen urban cities around the Netherlands. The 40 post-partum women had lived in the Netherlands for at least 10 years prior to participation in the study, spoke English proficiently, and had a vaginal birth within the past 18 months. Additionally, participant observation occurred in midwifery practices. FINDINGS: analysis of the interviews revealed three key themes first, participants perceive childbirth pain as "natural" and positive, and approach its management through non-medical birth methods; second, participants prioritize autonomy in childbirth which they see as something they can "do on [their] own" without pain medication; and third, participants' decisions about using an epidural was supported by professional advice and social connections, such as friends and family members. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE women's conception of pain is central to decisions about childbirth in the Netherlands. This ethnographic research illustrates how perceptions and attitudes toward childbirth pain are affected by definitions of a "natural" birth, women's capacity to give birth, and the presence of professional and social support for non-medical births.