How Midwives Accomplish Natural Birth: Managing Risk and Balancing Expectations

A considerable body of research has been directed towards identifying the impediments to natural childbirth where much has been made of restraints by obstetrics. Drawing on data from observations, interviews, and medical records, I analyze midwife management of labor and delivery in a birth center. I show that a natural birth had to be achieved by midwives as they balanced obstetrical norms and authority, women's anxieties and expectations, and their own ideology. Because women's expectations for a natural birth were often qualified by concerns about pain and risk, the midwives had to build greater commitment to the natural midwifery model. The increased need to standardize birth to conform to obstetrical expectations, however, meant that natural birth could not always be upheld. The midwives' work could then conflict with the desires of their women clients. I conclude that a more complete understanding of how labor takes place needs to examine not only the expectations of obstetricians but also of women clients.