“Most Often People Would Tell Me I Was Crazy”: Defending against Deviance Ascribed to Alternative Birth Choices

Childbirth-related discourses and practices have fluctuated over time in Canada. A medicalized model currently dominates, but there is increasing plurality in how birth is conceptualized and enacted. From a sample of twenty-one first-time mothers who were interviewed about their childbirth-related experiences, we explored how women described and defended their alternative birth choices within the broader social context of medicalized birth. Data were thematically analyzed and explored in relation to theoretical work on stigma and deviance, since these concepts emerged as salient to women’s narrated experiences. Findings illustrate that mothers who make alternative childbirth choices are often marked as deviant and may elicit moralizing judgments from others, which largely stem from perceptions of risk and/or safety. To counter or avoid feared and experienced deviance, women managed information about the birth of their child through passing, covering, normalizing through reframing, and condemning the condemners. This information management allowed women to present themselves as responsible, competent mothers in the face of deviance. Although previous research has demonstrated birth-related stigma in relation to the choice to birth at home or unassisted, our findings suggest that ascriptions of deviance may also extend to women’s choice of midwifery and doula care despite their increasing prevalence as part of maternity care in Canada. Since these birth options are progressively available and used, and have some empirically documented benefits for mothers, further exploration of how they and other alternative childbirth options are perceived, experienced, and morally valued by women and the general public is warranted

The Moral Dimensions of Contemporary Childbirth

Although some childbirth experiences (e.g. caesarean section) appear to be understood in moral terms, there is a dearth of empirical work on how women situate birth experiences within a moral framework. The aim of the current doctoral research was therefore to explore how women morally position various childbirth related options, interventions, decisions, and experiences within their narratives of childbirth, and to explore how these narratives and moral valuations reflect broader ideologies of mothering and childbirth. Narrative interviews, in which women described their experiences with pregnancy, childbirth, and the transition to motherhood, were conducted with first-time mothers (N=21) who had given birth within the last 18 months. Interviews were analyzed using an inductive, thematic approach which explored both semantic and latent aspects of women’s narratives. Findings illustrated that women negotiated with both natural and medicalized understandings of childbirth, although tenets of alternative childbirth ideology were especially prominent in women’s narratives. Women frequently used a moral voice of justice and autonomy within their childbirth narratives, which brought the concepts of individual harm, rights, and justice to the fore and reflected a valuation of autonomy and choice. The salience of autonomy was further illustrated in how women’s autonomy was supported, constrained, or transgressed during labour and delivery, and the significance this had for how women felt about their childbirth experience. Additionally, women invoked a moral casual ontology and a moral voice of care wherein they described particular birth choices (e.g. epidural and induction) as potentially harmful, and situated the primary responsibility for birth outcomes in themselves and their decisions. Finally, women negotiated with moral, biomedical, and ideological frameworks in ways which helped them re/negotiate a positive moral and maternal identity in the wake of undesirable birth outcomes and birth-related stigma. Findings make visible the ways in which the moral dimensions of childbirth may be understood and negotiated by women, and offer insights into how maternity care can incorporate such understandings and promote supportive, respectful care

A needs assessment on addressing environmental health issues within reproductive health service provision: Considerations for continuing education and support

Background: This needs assessment was initially undertaken to explore the beliefs and knowledge of nurses and physicians about the impact of environmental toxicants on maternal and infant health, as well as to describe current practice and needs related to addressing environmental health issues (EHI).Methods: One hundred and thirty-five nurses (n = 99) and physicians (n = 36) working in Saskatchewan completed an online survey. Survey questions were designed to determine how physicians and nurses think about and incorporate environmental health issues into their practice and means of increasing their capacity to do so.Results: Although participants considered it important to address EHIs with patients, in actual practice they do so with only moderate frequency. Participants reported low levels of knowledge about EHIs’ impact on health, and low levels of confidence discussing them with patients. Participants requested additional information on EHIs, especially in the form of online resources.Conclusion: The results suggests that while nurses and physicians consider EHIs important to address with patients, more education, support, and resources would increase their capacity to do so effectively. Based on the findings, considerations and recommendations for continuing education in this area have been provided.

Changes in use of types of tobacco products by pack sizes and price segments, prices paid and consumption following the introduction of plain packaging in Australia

Objectives: To describe changes among smokers in use of various types of tobacco products, reported prices paid and cigarette consumption following the standardisation of tobacco packaging in Australia.Methods: National cross-sectional telephone surveys of adult smokers were conducted from April 2012 (6 months before transition to plain packaging (PP) to March 2014 (15 months afterwards). Multivariable logistics regression assessed changes in products, brands and pack types/sizes; multivariable linear regression examined changes in inflation-adjusted prices paid and reported cigarette consumption between the pre-PP and three subsequent periods &ndash; the transition phase, PP year 1 and PP post-tax (post a 12.5% tax increase in December 2013).Results: The proposition of current smokers using roll-your-own (RYO) products fluctuated over the study period. Proportions using value brands of factory-made (FM) cigarettes increased from pre-PP (21.4%) to PP year 1 (25.5%; p=0.002) and PP post-tax (27.8%; p&lt;0.001). Inflation-adjusted prices paid increased in the PP year 1 and PP post-tax phases; the largest increases were among premium FM brands, the smallest among value brands. Consumption did not change in PP year 1 among daily, regular or current smokers declined significantly in PP post-tax (mean=14.0, SE=0.33) compared to PP year 1 (mean=14.8, SE=0.17; p=0.037).Conclusions: Introduction of PP was associated with an increase in use of value brands, likely due to increased numbers available and smaller increases in prices for value relative to premium brands. Reported consumption declined following the December 2013 tax increase.<br /

Standardised packaging and new enlarged graphic health warnings for tobacco products in Australia--legislative requirements and implementation of the Tobacco Plain Packaging Act 2011 and the Competition and Consumer (Tobacco) Information Standard, 2011

This paper describes the development, content and implementation of two pieces of Australian tobacco control legislation: one to standardise the packaging of tobacco products and the other to introduce new, enlarged graphic health warnings. It describes the process of legislative drafting, public consultation and parliamentary consideration. It summarises exactly how tobacco products have been required to look since late 2012. Finally, it describes implementation, most particularly, the extent to which packs compliant with the legislation became available to consumers over time.<br /

Rethinking the fall of the planter class

This issue of Atlantic Studies began life as a one-day conference held at Chawton House Library in Hampshire, UK, and funded by the University of Southampton. The conference aimed, like this issue, to bring together scholars currently working on the history of the British West Indian planter class in the eighteenth and nineteenth centuries and to discuss how, when, and why the fortunes of the planters went into decline. As this introduction notes, the difficulties faced by the planter class in the British West Indies from the 1780s onwards were an early episode in a wider drama of decline for New World plantation economies. The American historian Lowell Ragatz published the first detailed historical account of their fall. His work helped to inform the influential arguments of Eric Williams, which were later challenged by Seymour Drescher. Recent research has begun to offer fresh perspectives on the debate about the decline of the planters, and this collection brings together articles taking a variety of new approaches to the topic, encompassing economic, political, cultural, and social histor

"More than a Craze: Photographs of New Zealand's early digital games scene"

Mahara Gallery website, Waikanae, New Zealand