The Reality of Resistance: The Experiences of Rural Parturient Women

Abstract

The closure of many local maternity services has given rise to contemporary realities of care for many rural parturient women in Canada, which, in turn, determines their experience of birth. To date, we do not have an understanding of the realities influencing the birthing experiences of rural parturient women. This qualitative investigation explored these issues with women from four rural British Columbian communities through semistructured interviews and focus groups. Women in this study articulated four realities that influenced the nature of their experience of birth, including geographic realities, the availability of local health service resources, and the influence of parity and financial implications of leaving the community to give birth. When these realities were incongruent with participants' needs in birth, participants developed strategies of resistance to mitigate the dissonance. Strategies included trying to time the birth at the referral hospital by undergoing an elective induction and seasonal timing of pregnancies to minimize the risk of winter travel. Some women showed up at the local hospital in an advanced stage of labor to avoid transfer to a referral center, or in some instances, had an unassisted homebirth.

Women׳s views about maternity care: How do women conceptualise the process of continuity?

“…A woman's desire for continuity across pregnancies is a likely extension of wanting relational aspects and systems of care continuity including good communication within the system, health providers and consistent policies (Green et al, 2000;Haggerty et al, 2003;Lees G, 1997). Rural women were more likely to report a desire for continuity of staff than urban women which may reflect the experiences and perceptions of limited choice regarding place of delivery in rural settings (Kornelsen & Grzybowski, 2006). Women in both urban and rural settings commented on a desire for continuity across locations, a finding that has not been reported elsewhere.…”

Women's expectations and experiences of maternity care in NSW – What women highlight as most important

“…Similar to a Canadian study of rural parturients, 31 close access was particularly important for rural multiparous women for whom there is stress incurred by the challenges of arranging care for other children, either in their own or referral communities and the stress of separation for those who had to leave their children behind. The mention of lack of available time among non-urban women in our study possibly reflects the staffing issues and particularly the inability to attract and retain staff in rural and remote obstetric services 22 .…”

Safety of labour and delivery following closures of obstetric services in small community hospitals

“…Travel for parous women often requires separation from older children and difficulties in arrangement of child care. 27 These considerations, informed by other research, must all be weighed when making decisions on closures of planned obstetric services.…”